Abstract
Objectives The optimal treatment choice of chronic carotid artery occlusion (CAO) remains inconclusive. This study was aimed at exploring the safety and effectiveness of hybrid surgery in the treatment of CAO and at determining predictors for successful recanalization. Methods In this study, we enrolled 37 patients with CAO who underwent hybrid surgical treatment during the period 2016–2018. We extracted and analyzed patients' demographic data, disease characteristics, surgical success rates, perioperative complications, and prognosis. Results A total of 37 patients with symptomatic CAO underwent hybrid surgical treatment. Thirty cases (81.1%) were successfully recanalized, while seven were not. Blood reflux after carotid endarterectomy occurred in 18 patients (60%) of the success group and 1 (14.3%) of the failure group (OR, 9.0; 95% CI, 0.95-54.5; P = 0.042). The rate of distal ICA reconstruction below the clinoid segment was 20 (66.7%) in the success group and 1 (14.3%) in the failure group (OR, 12.0; 95% CI, 1.3-113.7; P = 0.029). In patients with successful recanalization, no ischemic events occurred after surgery and during follow-up, but restenosis of >50% was found in one case. In the failure group, two patients experienced recurrent ischemic events during follow-up. Perfusion imaging in successful recanalization cases is significantly improved, preoperative I/C ratio was 1.44 (IQR 1.27-1.55), and postoperative 1.12 (IQR 1.05-1.23). National Institutes of Health Stroke Scale (NIHSS) score of successful recanalization cases was 5.35 (2.26) before surgery and 2.03 (1.40) at 6 months (P < 0.01). Conclusion Hybrid surgery might be a safe and effective way to treat CAO. Distal internal carotid artery reconstruction to below the clinoid segment and blood reflux after carotid endarterectomy are predictors of successful recanalization.
Highlights
Chronic carotid artery occlusion (CAO) is an uncommon but important cause of ischemic stroke
Inclusion criteria were as follows: (1) 18–80 years old, (2) complete carotid artery occlusion as confirmed by digital-subtraction angiography (DSA), (3) transient ischemic attack (TIA) or stroke occurring in the occluded blood vessel supply area over the past 12 months, (4) computed tomography (CT) or magnetic resonance (MR) perfusion imaging confirming hypoperfusion on the occluded side, (5) CT or MR excluding extensive cerebral infarction, and (6) cases with complete clinical and imaging data to permit follow-up
Of the 59 patients with symptomatic CAO who were admitted during the study period, a total of 37 patients were included in the study (Figure 3)
Summary
Chronic carotid artery occlusion (CAO) is an uncommon but important cause of ischemic stroke. The natural course of CAO varies greatly, and it can manifest as stroke, transient ischemic attack (TIA), or no symptoms at all. Territories of which blood supply is occluded rely on compensating collateral flow, but for some patients, these are not sufficient. Among patients with hemodynamic disorders, those with CAO have significantly higher rates of recurrent stroke and mortality [1]. Alternative treatments are as follows: conservative treatment including antiplatelets and anticoagulants, extracranial-intracranial (EC-IC) bypass, carotid endarterectomy (CEA), and endovascular recanalization
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