Hybrid surgery versus endovascular intervention for patients with chronic internal carotid artery occlusion: A single-center retrospective study

Abstract

ObjectiveChronic internal carotid artery occlusion (CICAO) can cause transient ischemic attack (TIA) and ischemic stroke. Carotid artery stenting (CAS) with embolic protection devices and hybrid surgery combining carotid endarterectomy and endovascular treatment are effective methods for carotid revascularization. The objective of this study was to evaluate and compare the effect and safety of the two surgical procedures.MethodsThis was a single-center retrospective study. In this study, 44 patients who underwent hybrid surgery and 35 who underwent endovascular intervention (EI) at our center were enrolled consecutively between May 2016 and March 2022. All patients were classified into four groups (A-D), as described by Hasan et al. We recorded and analyzed clinical data, angiographic characteristics, technical success rate, perioperative complications, and follow-up data.ResultsThere was no significant difference in baseline characteristics between hybrid surgery group and EI group, except for plasma high density lipoproteins (HDL) levels (median [interquartile range]: hybrid surgery, 0.99 [0.88–1.18] vs. EI, 0.85 [0.78–0.98] mmol/L, P = 0.001). The technical success rate of hybrid surgery was higher than that of EI (37/44 [84.1%] vs. 18/35 [51.4%], P = 0.002; type A: 15/16 [93.8%] vs. 10/11 [90.9%], P = 1.000; type B: 9/10 [90.0%] vs. 5/7 [71.4%], P = 0.537; type C: 12/15 [80.0%] vs. 3/12 [25.0%], P = 0.004; type D: 1/3 [33.3%] vs. 0/5 [0%], P = 0.375). No significant difference was observed in the incidence of perioperative complications between the two procedures (hybrid surgery: 7/44 [15.9%] vs. EI: 6/35 [17.1%], P = 0.883). In addition, there were no significant differences in the rates of stroke and restenosis during follow-up.ConclusionsFor patients with symptomatic CICAO, hybrid surgery may have an advantage over EI in successfully recanalizing occluded segments. There was no significant difference in safety and restenosis between hybrid surgery and EI.

Safety and Efficacy of Hybrid Surgery in Chronic Internal Carotid Artery Occlusion: A Systematic Review and Meta-Analysis

“…Thirteen studies reported the time and method of surgical follow-up for 246 patients. The shortest follow-up time was 4 months [16] after surgery, and the longest follow-up time was 49 months [21] after surgery. A total of 19 (7.7%) patients who were followed up reported recurrences of stenosis and 17 (6.9%) cases of reocclusion.…”

“…Duplicate articles, title abstracts, and full texts were screened, and irrelevant articles, case reports, and letters were excluded. One study with carotid stent restenosis hybrid surgery recanalization was excluded, and 16 eligible studies were finally included [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Fig. 2).…”

Recanalization of chronic long-segment occlusion of the internal carotid artery with endovascular and hybrid surgery

“…The hybrid approach consists of endovascular stent angioplasty and carotid endarterectomy. In the study investigating the effect of hybrid and endovascular treatment of patients with chronic ICA occlusion 2 , the successful recanalization rate was 84.1% in patients with the hybrid surgery versus 51.4% in those with endovascular treatment. During the follow-up over 24 months, one patient died of a cardiovascular event, recurrent stroke took place in one unsuccessful patient, one patient had restenosis and one patient had reocclusion in the hybrid surgery group.…”