Abstract Details

Title Safety and Efficacy of Endovascular Interventions for Chronic Carotid Artery Occlusion: A Multi-Center Case Series

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-019

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.

Authors/Disclosures
Jenny Huynh PRESENTER	Ms. Huynh has nothing to disclose.
Anderson Brito-Alvarado, MD	Dr. Brito-Alvarado has nothing to disclose.
Leonardo Cruz, MD (University of Iowa)	Dr. Cruz has nothing to disclose.
Milagros Galecio-Castillo, MD	Dr. Galecio-Castillo has nothing to disclose.
Randall G. Krug II, MD, PhD (UIHC Department of Neurology)	Dr. Krug has nothing to disclose.
Piyush Kalakoti, MBBS	Dr. Kalakoti has nothing to disclose.
Serdar Geyik (Istanbul Aydin University)	No disclosure on file
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.
Arsida Bajrami, MD	Dr. Bajrami has nothing to disclose.

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