Clinical efficacy and safety analysis of multimodal image-guided hybrid operation for symptomatic chronic internal carotid artery occlusion

Abstract

Objective To explore the efficacy and safety of multimodal image-guided hybrid operation in the treatment of symptomatic chronic internal carotid artery occlusion (CICAO). Methods and Results Total 25 patients with symptomatic CICAO who underwent hybrid operation in Tianjin Huanhu Hospital from July 2018 to August 2023 were enrolled. All patients completed preoperative multimodal imaging examinations, including cervical vascular ultrasound, transcranial Doppler ultrasonography (TCD), CTA or DSA, CT perfusion imaging (CTP) or perfusion-weighted imaging (PWI), and high-resolution MRI (HRMRI). Carotid endarterectomy (CEA) combined with endovascular treatment was performed in the hybrid operating room. Vascular recanalization was successfully achieved in all patients after surgery, with a success rate of 100% (25/25). One day after surgery, 25 patients underwent head CT, and one had intraoperative subarachnoid hemorrhage. Within 7 d after surgery, 24 patients underwent CTP or PWI, all of which showed improved perfusion flow compared with preoperation. Within 7 d after surgery, 25 patients underwent head MRI, and 4 had cerebral infarction. Within 7 d after surgery, 24 patients underwent cervical vascular ultrasound or TCD, all of which showed patency of the internal carotid artery (ICA). The mean National Institutes of Health Stroke Scale (NIHSS) scores at discharge, 6 months and one year after surgery were 3.36, 2.72 and 2.72; the mean modified Rankin Scale (mRS) scores were 0.76, 0.60 and 0.60. The perioperative complication rate was 20% (5/25). The average follow-up time was 24.88 months, and the affected ICA restenosis rate was 16% (4/25); no patient had reocclusion of the affected ICA. Conclusions Multimodal image-guided hybrid operation is technically feasible and safe and effective in clinical application, providing a new treatment option for symptomatic CICAO.

Keywords

• carotid artery thrombosis
• carotid artery， internal
• endarterectomy， carotid
• saccule and utricle
• stents
• multimodal imaging