Mid-/Long-Term Outcome of Neuroendovascular Treatment for Chronic Carotid Artery Total Occlusion

Abstract

The natural course of chronic carotid artery total occlusion (CTO) is poor. Previous reports suggested that carotid artery stenting (CAS) improves the clinical outcome of CTO. However, its long-term efficacy has not been established. This study assessed the mid-and long-term clinical outcome of CAS for CTO. Methods: We evaluated the clinical outcome of 15 patients who underwent CAS for CTO between September 2010 and October 2019. Results: The technical success rate of recanalization was 93.3% (14 of 15 patients). Eight patients were treated using selfexpanding stents, and six were treated using self-expanding coronary stents. Symptomatic procedure-related complications developed in two patients (13.3%). During the follow-up period (mean 34.9 months), symptomatic ipsilateral stroke was not noted. One patient (7.1%) developed asymptomatic re-occlusion, but stent patency was preserved in 13 patients (92.9%). Conclusion: CAS for CTO may be safe and feasible based on the mid-and long-term outcome. Keywords▶ chronic carotid artery total occlusion, carotid artery stenting, ischemic stroke, long and mid-term outcome However, the COSS trial 4) denied the usefulness of EC-IC bypass. Furthermore, another study reported the success rate of CEA for CTO to be 34%. 5) Revascularization for chronic total occlusion of the coronary or iliac arteries using a stent leads to a high recanalization rate with a low incidence of complications, resulting in a favorable vascular patency rate and ischemic symptom prevention during long-term follow-up. 6,7) Recent studies, including one conducted by Terada et al., 1) reported revascularization by percutaneous carotid artery stenting (CAS) for CTO, and suggested favorable treatment results from the viewpoint of stroke prevention. 1,2,8-10). However, its long-term outcome remains to be clarified. In this study, we report the mid-/long-term postoperative outcome of treatment in 15 patients in whom CAS for CTO was performed at our institution. Materials and Methods CAS was performed at our institution on 15 patients of 27 patients diagnosed with CTO between September 2010 and October 2019 (Table 1). Their ages ranged from 37 to 83 years, with a mean of 66.6 years. They consisted of 12 males and 3 females. Left lesions were present in six patients, internal carotid artery-localized This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

Modern endovascular management of chronic total carotid artery occlusion: technical results and procedural challenges

“…The main reason for our failure to revascularize left common carotid occlusions is the lack of proximal support, regardless of the guide catheter used, which hampered our ability to progress our microcatheter dissection further than the angle of the mandible. Failure to obtain access to the true ICA lumen was pointed out previously as the main reason for technical failure 13. From our experience, lack of support in creating a transmural dissection with the 5-French vertebral catheter in the proximal portion of the occluded vessel leads to subsequent failure of advancing the 0.014" guidewire and 0.017" microcatheter through long occlusions.…”

“…This population of patients poses several problems for clinicians, and different endovascular and hybrid surgery therapies have been proposed since the failure of bypass surgery in the Carotid Occlusion Surgery Study (COSS) trial 11–13. Pure endovascular recanalization was recently described, and the results of several case series were reviewed in a meta-analysis which found an overall successful recanalization of 70% with procedural associated morbidity of 5%.…”