Comparative efficacy of endovascular treatment alone versus hybrid operation for symptomatic chronic internal carotid artery occlusion

Abstract

Objective To evaluate and compare the efficacy and safety of endovascular treatment alone versus hybrid operation in the treatment of symptomatic chronic internal carotid artery occlusion (CICAO). Methods A total of 103 patients with symptomatic CICAO who underwent hybrid operation (n = 60) or endovascular treatment alone (n = 43) in Qilu Hospital of Shandong University from May 2016 to March 2025 were included. All cases were classified into 4 types, namely type A, type B, type C and type D by preoperative DSA examination combined with Hasan classification. The vascular recanalization success rate, as well as the incidence of complications during the perioperative period, follow-up period and in the vascular recanalization cases were recorded. Results The vascular recanalization success rate of the hybrid operation group was higher than that of the endovascular treatment alone group (χ2 = 10.885, P = 0.001). Analysis by Hasan classification showed that Hasan type C had more advantages with hybrid operation (Fisher's exact probability: P = 0.024). There was no statistically significant difference in the incidence of perioperative complications between the hybrid operation group and the endovascular treatment alone group (χ2 = 0.008, P = 0.928). The median follow-up time of the hybrid operation group was 33.00 (11.25, 52.75) months, and the median follow-up time of the endovascular treatment alone group was 24 (15, 30) months. During the follow-up period, there were no statistically significant differences in mortality (Fisher's exact probability: P = 1.000), the incidence of new transient ischemic attack/ischemic stroke (Fisher's exact probability: P = 0.251), and the incidence of restenosis/reocclusion of the affected internal carotid artery in vascular success recanalization cases (Fisher's exact probability: P = 0.210). Conclusions For patients with CICAO, hybrid operation achieves a higher vascular recanalization success rate. This surgical approach is both safe and feasible, and may be particularly beneficial for patients with more complex anatomical features (Hasan type C). There were no significant differences between hybrid operation and endovascular treatment alone in terms of safety and the incidence of postoperative restenosis/reocclusion of affected internal carotid artery.

Keywords

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