Outcomes of Revascularization in Patients with Symptomatic Chronic Internal Carotid Artery Occlusion: Insights from a Case Series.

Introduction: Symptomatic chronic occlusion of the internal carotid artery (COICA) represents a significant therapeutic challenge. Patients often continue to suffer from hypoperfusion symptoms or recurrent ischemic events despite maximal medical management. Although revascularization has not demonstrated clear long-term functional benefits in chronic occlusion, it may serve as a salvage technique for these symptomatic patients. This case series analysis describes the clinical outcomes following revascularization in COICA.

Methods: A retrospective review was conducted on patients with COICA treated by the senior author (RGT). Chart reviews provided relevant data on demographic and clinical variables. Patients were classified as having typical or atypical COICA based on the pattern of distal reconstitution; the latter involved recanalization through vasa vasorum. Functional outcomes were assessed with the modified Rankin Scale (mRS), with scores ≤2 indicating good functional status.

Results: The series included 17 patients (82.3% male, mean age 66.18). Prior neck radiation and a history of smoking were reported in 11.76% and 64.72% of the patients, respectively. A significant majority had a history of stroke (82%) and transient ischemic attacks (47.06%). Bilateral COICA was observed in 41% of cases, with the carotid bifurcation being the most common occlusion site. Atypical COICA was noted in 35.29%. Endovascular approaches were successfully performed in 76.47% of cases, with bypass performed in the rest. Of those treated endovascularly, nine underwent stenting plus balloon angioplasty and four balloon angioplasties. Complications occurred in 52.94% of patients. 17.65% experienced ischemic strokes during follow-up. No statistically significant change in functional status was observed pre-and post-intervention.

Conclusion : Our analysis shows that while there was no significant difference in functional status pre- and postoperatively, the pronounced decline in follow-up stroke rates emerges as the main benefit of revascularization in patients with COICA. However, the risk of complications remains elevated, underscoring the need for adequate patient selection.