Efficacy and safety analysis of hybrid operation for symptomatic chronic common carotid artery occlusion

Abstract

Objective To explore the technical key points, clinical efficacy and safety of hybrid operation for symptomatic chronic common carotid artery occlusion (CCAO). Methods and Results A total of 10 patients with symptomatic chronic CCAO who underwent hybrid operation in The First Affiliated Hospital of Harbin Medical University from December 2022 to October 2024 were included. The median preoperative modified Rankin Scale (mRS) score was 2 (1, 2). All patients successfully completed revascularization with a technical success rate of 10/10, including 6 cases treated with carotid endarterectomy (CEA) combined with retrograde transcarotid recanalization (for patients with short CCA residual stumps) and 4 cases treated with CEA combined with antegrade transfemoral recanalization (for patients with long CCA residual stumps). Postoperative complications included one case of cerebral hyperperfusion syndrome (CHS), with no occurrence of neck hematoma, hemorrhagic stroke, ischemic stroke or transient ischemic attack. During a median follow-up of 10 (9, 12) months, there were no cases of restenosis requiring retreatment, ipsilateral ischemic stroke or transient ischemic attack. The median mRS score at last follow-up was 0 (0, 1). The last follow-up mRS score was lower than the preoperative mRS score (Z = - 0.289, P = 0.004). Conclusions The hybrid operation is safe and effective for treating symptomatic chronic CCAO. In clinical practice, CEA combined with retrograde transcarotid recanalization may demonstrate relatively significant advantages for symptomatic chronic CCAO with shorter residual stumps, potentially facilitating more optimal revascularization outcomes. However, further case validation remains necessary.

Keywords

• carotid artery thrombosis
• carotid arterty， common
• endarterectomy， carotid
• saccule and utricle
• stents