Outcomes of Carotid Artery Stenting in Near-Occlusion without Collapse: A Comparative Analysis with Severe Carotid Stenosis

Objective: The current study aimed to compare the technical success, safety, and efficacy of carotid artery stenting (CAS) in patients with carotid near-occlusion without collapse with patients with severe carotid stenosis. The findings can provide insight into the clinical implications of treating near-occlusion without collapse as a distinct pathological entity. Methods: A retrospective evaluation was conducted on 50 patients who had undergone CAS: 25 patients with carotid near-occlusion without collapse (Group 1) and 25 age- and sex-matched controls with severe carotid stenosis (≥70%) (Group 2). Diagnosis of near-occlusion was based on digital subtraction angiography findings, following established criteria, and all procedures were performed electively. Technical success, peri-procedural complications, and long-term outcomes were evaluated. The study focused on angiographic features, stent types, complications, and restenosis rates in the Group 1 patients. Results: A comparable technical success rate (100%) was observed between the two study groups. In Group 1, periprocedural events were observed in three patients: two developed hypotension requiring adrenergic support, and one experienced bradycardia lasting 24 hours. In Group 2, two patients developed hypotension requiring medical treatment. Peri-procedural complications occurred in 8% and 12% of patients in Groups 1 and 2, respectively, with no significant difference (p=0.637). A median follow-up of 22.5 months in Group 1 and 28 months in Group 2 indicated symptomatic stroke rates of 4% in both groups, with no new symptomatic ischemic strokes observed beyond the peri-procedural period. Conclusions: CAS in patients with near-occlusion without collapse demonstrated outcomes comparable to those with severe carotid stenosis, with similar rates of technical success, complications, and long-term efficacy.