J Cerebrovasc Endovasc Neurosurg.  2023 Mar;25(1):1-12. 10.7461/jcen.2022.E2022.03.008.

Sixteen years progress in recanalization of chronic carotid artery occlusion: A comprehensive review

Affiliations
  • 1Department of Neurosurgery, Main Military Hospital Named after N.N. Burdenko, Moscow, Russia
  • 2Department of Neurosurgery, Military Medical Academy Named after S.M. Kirov, Saint-Petersburg, Russia

Abstract


Objective
Although chronic carotid artery occlusion seems to be associated with significant risk of ischemic stroke, revascularization techniques are neither well established nor widespread. In contrast, extracranial-intracranial bypass is common despite the lack of evidence regarding neurological improvement or prevention of ischemic events. The aim of current review is to evaluate the effectiveness of various methods of recanalization of chronic carotid artery occlusion.
Methods
Comprehensive literature search through PubMed, Scopus, Cochrane and Web of Science databases performed. Various parameters were assessed among patients underwent surgical, endovascular and hybrid recanalization for chronic carotid artery occlusion.
Results
40 publications from 2005 to 2021 with total of more than 1300 cases of revascularization of chronic carotid artery occlusion have been reviewed. Further parameters were assessed among patients underwent surgical, endovascular and hybrid recanalization for chronic carotid artery occlusion: mean age, male to female ratio, mean duration of occlusion before treatment, rate of successful recanalization, frequency of restenosis and reocclusion, prevalence of ischemic stroke postoperatively, neurological or other symptoms improvement and complications. Based on proposed through reviewed literature indications for revascularization and predictive factors of various recanalizing procedures, an algorithm for clinical decision making have been formulated.
Conclusions
Although treatment of chronic carotid artery occlusion remains challenging, current literature suggests revascularization as single option for verified neurological improvement and prevention of ischemic events. Surgical and endovascular procedures should be taken into account when treating patients with symptomatic chronic carotid artery occlusion.

Keyword

Carotid artery stenosis; Transluminal angioplasty; Carotid endarterectomy; Bypass surgery; Stroke

Figure

  • Fig. 1. Methodology of literature search.

  • Fig. 2. Distribution of papers published from 2005 to 2021.

  • Fig. 3. Proposed algorithm for clinical decision making based on review.


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