Safety and Efficacy of Endovascular Interventions for Chronic Carotid Artery Occlusion: A Multi-Center Case Series
Jenny Huynh1, Anderson Brito-Alvarado1, Leonardo Cruz1, Milagros Galecio-Castillo1, Randall Krug1, Piyush Kalakoti1, Serdar Geyik2, Santiago Ortega Gutierrez1, Arsida Bajrami3
1Neurology, University of Iowa Health Care, 2Radiology, 3Neurology, Istanbul Aydin University
Objective:
This study aims to evaluate the safety and efficacy of endovascular treatment (EVT) of symptomatic chronic carotid occlusions (CCO).
Background:
Symptomatic chronic carotid occlusions (CCO) significantly increase the risk of ischemic events, even among patients receiving medical management. There is a lack of definitive treatment guidelines, and EVT has arisen as a potential, minimally invasive option for recanalizing the occluded vessel. In this case series, we aim to assess the safety and efficacy of EVT for treating CCO.
Design/Methods:
We conducted a retrospective case series study of CCO patients treated between 2014 and 2023 from two comprehensive stroke centers. Inclusion criteria included adult patients, symptomatic status, and EVT treatment. The occlusions were identified through neuroimaging or by the known duration of the occlusion (≥1 month). Efficacy was defined as procedure success (defined by deployment of stent). Safety outcomes were defined as periprocedural complications (during or ≤30 days after procedure) including hemodynamic impairment (bradycardia/hypotension), symptomatic intracranial hemorrhage, restenosis or reocclusion, and the presence of new ischemic lesions.
Results:
From 212 patients, 32 met the inclusion criteria, of which 34.3% (n=11) were females. The median age was 65.5 years [IQR 57.75-71.5]. Hypertension was present in 90.6% (29) of patients, 78.1% (25) were smokers, and 62.5% (20) had dyslipidemia. Additionally, 43.7% (14) had type 2 diabetes mellitus. Successful treatment was achieved in 62.5% (20) of cases. Periprocedural complications included hypotension in 28.1% (9) of patients, bradycardia in 25% (8), reocclusion in 6.25% (2), and restenosis in 3.12% (1). New ischemic lesions were observed in 31.2% (10), of which 70% (7) compromise anterior cerebral circulation.
Conclusions:
Our case series study showed a low rate of periprocedural complications, suggesting that EVT for symptomatic CCO is a safe procedure. Although the success rate aligns with previous studies, it highlights the need to improve EVT techniques for these patients.
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