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Surgical therapy for chronic internal carotid artery occlusion: a systematic review and meta-analysis

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Abstract

Chronic internal carotid artery occlusion (CICAO) significantly increases the risk of recurrent stroke. Given unfavorable outcomes, revascularization procedures are not generally recommended for CICAO. In the last several years, loads of studies reported successful surgical revascularization for CICAO with promising success rate and favorable short-term outcomes. Meanwhile, due to the lack of high-quality evidence, the safety and efficacy of revascularization procedures remain debatable. This systematic review aims to scrutinize current evidence for the applicability of revascularization for CICAO. We also investigated potential predictors of postoperative prognosis. We searched clinical studies on surgical treatment of CICAO on the Medline, Cochrane library, and Embase databases, published from Jan 1990 to Jan 2021. Surgical operation was restricted to bypass surgery, endarterectomy, endovascular therapy, and hybrid surgery. Controlled clinical studies were included for clinical outcomes. Large-sample single-arm studies were supplemented to assess complications and success rate. Co-primary endpoints were technical success rate and neurological function; secondary endpoints were recurrent stroke/cerebrovascular events, complications, and deaths within follow-up. This systematic review has been registered in PROSPERO (CRD42020181250). One RCT and 5 cohort studies with a total of 465 patients were included in this review. Seven single-arm studies were supplemented for assessing success rate and complications. Bypass surgery presented the highest graft patency of 96% and a low incidence of complications, but no benefits on neurological function, recurrent stroke, or deaths. Endovascular therapy (carotid stenting) was characterized by a relatively lower technical success rate, significant neurological function recovery, and nonsignificant reduction of cerebrovascular events and deaths. Hybrid surgery was considered as a potential treatment for CICAO because of a high technical success rate and significant neurological improvement. Endarterectomy is only suitable for short-segment occlusion. Prospective clinical trials should focus on carotid stenting and hybrid surgery for their significant capacity of improving neurologic function and potential capacity of reducing deaths and cerebrovascular events.

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References

  1. Hennerici M, Hülsbmer HB, Rautenberg W, Hefter H (1986) Spontaneous history of asymtomatic internal carotid occlusion. Stroke 17(4):718–722. https://doi.org/10.1161/01.str.17.4.718

    Article  PubMed  CAS  Google Scholar 

  2. Paty PS, Adeniyi JA, Mehta M, Darling RC 3rd, Chang BB, Kreienberg PB et al (2003) Surgical treatment of internal carotid artery occlusion. J Vasc Surg 37(4):785–788. https://doi.org/10.1067/mva.2003.203

    Article  PubMed  Google Scholar 

  3. Grubb RL Jr, Powers WJ (2001) Risks of stroke and current indications for cerebral revascularization in patients with carotid occlusion. Neurosurg Clin N Am 12(3):473–487. https://doi.org/10.1016/j.solener.2004.09.009

    Article  PubMed  CAS  Google Scholar 

  4. Yamauchi H, Kudoh T, Kishibe Y, Iwasaki J, Kagawa S (2007) Selective neuronal damage and chronic hemodynamic cerebral ischemia. Ann Neurol 61(5):454–465. https://doi.org/10.1002/ana.21104

    Article  PubMed  Google Scholar 

  5. Marquardt L, Geraghty OC, Mehta Z, Rothwell PM (2009) Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment a prospective, population-based study. Stroke 41(1):e11–e17. https://doi.org/10.1161/STROKEAHA.109.561837

    Article  PubMed  Google Scholar 

  6. Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL et al (2013) 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv 81(1):76–123. https://doi.org/10.1002/ccd.22983

    Article  Google Scholar 

  7. Group EIBS (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: results of an international randomized trial. N Engl J Med. https://doi.org/10.1056/NEJM198511073131904

    Article  Google Scholar 

  8. Brott TG, Hobson RW, Howard G, Roubin GS, Malas M (2010) Stenting versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med 363(1):11–33. https://doi.org/10.1016/j.jvs.2010.07.042

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Bonati LH, Dobson J, Featherstone RL, Ederle J, Halliday A (2014) Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet 385(9967):529–538. https://doi.org/10.1016/S0140-6736(14)61184-3

    Article  PubMed  Google Scholar 

  10. Powers WJ, Clarke WR, Grubb RL Jr, Videen TO, Adams HP Jr, Derdeyn CP et al (2011) Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA 306(18):1983–1992. https://doi.org/10.1001/jama.2011.1610

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Nemoto S (2018) Endovascular revascularization of chronic total occlusion of the internal carotid artery. Neuroradiology 60:S511–S512. https://doi.org/10.1007/s00234-018-2057-6

    Article  Google Scholar 

  12. Cagnazzo F, Dargazanli C, Lefevre PH, Gascou G, Derraz I, Riquelme C et al (2020) Chronic occlusion of the internal carotid artery: endovascular revascularization technique of long occlusive lesions. J Neuroradiol 47(4):318–322. https://doi.org/10.1016/j.neurad.2019.05.005

    Article  PubMed  Google Scholar 

  13. Jia ZC, Li X, Zheng M, Luan JY, Wang CM, Han JT (2020) Hybrid treatment for symptomatic long-segment chronic internal carotid artery occlusion without stump. Beijing da xue xue bao Yi xue ban J Peking Univ Health Sci 52(1):177–180. https://doi.org/10.19723/j.issn.1671-167X.2020.01.028

    Article  CAS  Google Scholar 

  14. Fan W, Li B, Qu X, Deng X, Jiang B, Liu Y et al (2019) Hybrid operation for the treatment of chronic internal carotid artery occlusion: preliminary application and clinical effect. J Interv Radiol 28(2):147–150. https://doi.org/10.3969/j.issn.1008-794X.2019.02.010

    Article  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ishikawa T, Yasui N, Suzuki A, Hadeishi H, Shishido F, Uemura K (1992) STA-MCA bypass surgery for internal carotid artery occlusion–comparative follow-up study. Neurol Med Chir 32(1):5–9. https://doi.org/10.2176/nmc.32.5

    Article  CAS  Google Scholar 

  17. Fan YL, Wan JQ, Zhou ZW, Chen L, Wang Y, Yao Q et al (2014) Neurocognitive improvement after carotid artery stenting in patients with chronic internal carotid artery occlusion: a prospective, controlled, single-center study. Vasc Endovasc Surg 48(4):305–310. https://doi.org/10.1177/1538574414525863

    Article  Google Scholar 

  18. Xia ZY, Yang H, Xu JX, Zhang M, Qu HQ, Xu GL et al (2012) Effect of stenting on patients with chronic internal carotid artery occlusion. Int Angiol 31(4):356–360. https://doi.org/10.1258/phleb.2012.012016

    Article  PubMed  Google Scholar 

  19. Hrbáč T, Beneš V, Širůček P, Jonszta T, Herzig R, Procházka V et al (2012) Safety and efficacy of surgical treatment of carotid stump syndrome: pilot study. Ann Vasc Surg 26(6):797–801. https://doi.org/10.1016/j.avsg.2011.11.034

    Article  PubMed  Google Scholar 

  20. Zhang K, Gao BL, Zhao TY, Li TX, Xue JY, He YK et al (2019) Hybrid operation to revascularize long-segment occluded internal carotid artery prevent further ischemic events. Neuroradiology 61(2):217–224. https://doi.org/10.1007/s00234-018-2145-7

    Article  PubMed  Google Scholar 

  21. Lee CW, Lin YH, Liu HM, Wang YF, Chen YF, Wang JL (2016) Predicting procedure successful rate and 1-year patency after endovascular recanalization for chronic carotid artery occlusion by CT angiography. Int J Cardiol 221:772–776. https://doi.org/10.1016/j.ijcard.2016.07.127

    Article  PubMed  Google Scholar 

  22. Chen YH, Leong WS, Lin MS, Huang CC, Hung CS, Li HY et al (2016) Predictors for successful endovascular intervention in chronic carotid artery total occlusion. JACC Cardiovasc Interv 9(17):1825–1832. https://doi.org/10.1016/j.jcin.2016.06.015

    Article  PubMed  Google Scholar 

  23. Kao HL, Hung CS, Li HY, Yeh CF, Huang CC, Chen YH et al (2018) Long-term outcomes after endovascular recanalization in patients with chronic carotid artery occlusion. Am J Cardiol 122(10):1779–1783. https://doi.org/10.1016/j.amjcard.2018.07.049

    Article  PubMed  Google Scholar 

  24. Lin MS, Lin LC, Li HY, Lin CH, Chao CC, Hsu CN et al (2008) Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion. Circ Cardiovasc Interv 1(2):119–125. https://doi.org/10.1161/CIRCINTERVENTIONS.108.772350

    Article  PubMed  Google Scholar 

  25. Jiao L, Song G, Hua Y, Ma Y, Chen Y, Wang Y et al (2013) Recanalization of extracranial internal carotid artery occlusion: a 12-year retrospective study. Neural Regen Res 8(23):2204–2206. https://doi.org/10.3969/j.issn.1673-5374.2013.23.011

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jiang WJ, Liu AF, Yu W, Qiu HC, Zhang YQ, Liu F et al (2019) Outcomes of Multimodality in situ Recanalization in Hybrid Operating Room (MIRHOR) for symptomatic chronic internal carotid artery occlusions. J NeuroInterventional Surg 11(8):825–832. https://doi.org/10.1136/neurintsurg-2018-014384

    Article  Google Scholar 

  27. Yang Y, Liu X, Wang R, Zhang Y, Zhang D, Zhao J (2020) A treatment option for symptomatic chronic complete internal carotid artery occlusion: hybrid surgery. Front Neurosci 14:392. https://doi.org/10.3389/fnins.2020.00392

    Article  PubMed  PubMed Central  Google Scholar 

  28. Yeh CF, Chen YH, Lin MS, Huang CC, Hung CS, Meng SW et al (2018) Carotid-cavernous fistula after endovascular intervention for chronic carotid artery total occlusion. Catheter Cardiovasc Interv 91(4):735–741. https://doi.org/10.1002/ccd.27392

    Article  PubMed  Google Scholar 

  29. Chen YH, Kao HL (2017) Concern on article “Predicting procedure successful rate and 1-year patency after endovascular recanalization for chronic carotid artery occlusion by CT angiography.” Int J Cardiol 229:59. https://doi.org/10.1016/j.ijcard.2016.11.274

    Article  PubMed  Google Scholar 

  30. Cagnazzo F, Lefevre PH, Derraz I, Dargazanli C, Gascou G, Riquelme C et al (2020) Endovascular recanalization of chronically occluded internal carotid artery. J Neurointerv Surg. https://doi.org/10.1136/neurintsurg-2019-015701

    Article  PubMed  Google Scholar 

  31. Al-Mufti F, Amuluru K, Manning NW, Khan I, Peeling L, Gandhi CD et al (2017) Emergent carotid stenting and intra-arterial abciximab in acute ischemic stroke due to tandem occlusion. Br J Neurosurg 31(5):573–579. https://doi.org/10.1080/02688697.2017.1297377

    Article  PubMed  Google Scholar 

  32. Zhang J, Liu Y, Jia L, Liu B, Meng X, Yang J et al (2015) Evaluation of endarterectomy recanalization under ultrasound guidance in symptomatic patients with carotid artery occlusion. PLoS ONE. https://doi.org/10.1371/journal.pone.0144381

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yu Z, Shi X, Qian H, Liu F, Zhou Z, Sun Y et al (2016) Internal maxillary artery to intracranial artery bypass: a case series of 31 patients with chronic internal carotid/middle cerebral arterial-sclerotic steno-occlusive disease. Neurol Res 38(5):420–428. https://doi.org/10.1080/01616412.2016.1177931

    Article  PubMed  CAS  Google Scholar 

  34. Shih YT, Chen WH, Lee WL, Lee HT, Shen CC, Tsuei YS (2012) Hybrid surgery for symptomatic chronic total occlusion of carotid artery: a technical note. Neurosurgery. https://doi.org/10.1227/NEU.0b013e31827fca6c

    Article  PubMed  Google Scholar 

  35. Li J, Wang C, Zou S, Liu Y, Qu L (2019) Hybrid surgery for nontaper or nonstump lesions in symptomatic subacute or chronic internal carotid occlusion: a better solution. World Neurosurg 122:e1416–e1425. https://doi.org/10.1016/j.wneu.2018.11.075

    Article  PubMed  Google Scholar 

  36. Rizk H, Allam M, Hegazy A, Khalil H, Helmy H, Hashem HS et al (2019) Predictors of poor cerebral collaterals and cerebrovascular reserve in patients with chronic total carotid occlusion. Int J Neurosci 129(5):455–460. https://doi.org/10.1080/00207454.2018.1538990

    Article  PubMed  Google Scholar 

  37. Sundaram S, Kannoth S, Thomas B, Sarma PS, Sylaja PN (2017) Collateral assessment by CT angiography as a predictor of outcome in symptomatic cervical internal carotid artery occlusion. AJNR Am J Neuroradiol 38(1):52–57. https://doi.org/10.3174/ajnr.A4957

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Grubb RL, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO et al (1998) Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 280(12):1055–1060. https://doi.org/10.1097/00008506-199904000-00018

    Article  PubMed  Google Scholar 

  39. Grubb RL Jr, Powers WJ, Clarke WR, Videen TO, Adams HP Jr, Derdeyn CP et al (2013) Surgical results of the Carotid Occlusion Surgery Study. J Neurosurg 118(1):25–33. https://doi.org/10.3171/2012.9.JNS12551

    Article  PubMed  Google Scholar 

  40. Kataoka H, Miyamoto S, Ogasawara K, Iihara K, Takahashi JC, Nakagawara J et al (2015) Results of prospective cohort study on symptomatic cerebrovascular occlusive disease showing mild hemodynamic compromise [Japanese Extracranial-Intracranial Bypass Trial (JET)-2 study]. Neurol Med Chir 55(6):460–468. https://doi.org/10.2176/nmc.oa.2014-0424

    Article  Google Scholar 

  41. Liu B, Wei W, Wang Y, Yang X, Yue S, Zhang J (2018) Estimation and recanalization of chronic occluded internal carotid artery: hybrid operation by carotid endarterectomy and endovascular angioplasty. World Neurosurg 120:e457–e465. https://doi.org/10.1016/j.wneu.2018.08.104

    Article  PubMed  Google Scholar 

  42. Nomura S, Yamaguchi K, Ishikawa T, Kawashima A, Okada Y, Kawamata T (2019) Clinical factors influencing the development of extracranial-intracranial bypass graft for steno-occlusive cerebrovascular disease. Neurosurg Focus 46(2):E5. https://doi.org/10.3171/2018.11.FOCUS18500

    Article  PubMed  Google Scholar 

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Funding

This article is supported by National Natural Science Foundation of China (NSFC) (Grant Number: 81870354).

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Authors and Affiliations

  1. Department of Vascular Surgery, Second Hospital, Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi, People’s Republic of China

    Genmao Cao, Jie Hu, Qinqin Tian & Honglin Dong

  2. Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA

    Wayne W. Zhang

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  1. Genmao Cao
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  2. Jie Hu
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  4. Honglin Dong
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Correspondence to Honglin Dong.

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It is a systematic review of literatures and all included studies are obtained from database like Medline, while no participant was enrolled. Therefore, ethical approval and informed consent were not required.

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Supplementary file1. Supplemental Table 1. PRISMA 2009 checklist. (DOC 65 kb)

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Cao, G., Hu, J., Tian, Q. et al. Surgical therapy for chronic internal carotid artery occlusion: a systematic review and meta-analysis. Updates Surg 73, 2065–2078 (2021). https://doi.org/10.1007/s13304-021-01055-x

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