Introduction Chronic internal carotid artery occlusion (CICAO) can result in recurrent ischemic events despite optimal medical therapy. Revascularization may serve as salvage treatment for symptomatic patients who fail medical management. Objective To evaluate the clinical outcomes of endovascular revascularization in patients with symptomatic CICAO. Methods We reviewed consecutive cases of symptomatic CICAO (symptoms ≥4 weeks) undergoing attempted endovascular revascularization between 2011 and 2024. Occlusions were classified as typical (complete) or atypical (pseudo‐occlusion or distal reconstitution via vasa‐vasorum). Outcomes included periprocedural complications (≤24 hours), technical failure, and new ischemic stroke or TIA during follow‐up. Functional status was assessed using the mRS before and after the procedure, with a favorable outcome defined as mRS ≤2. Results Twenty‐five patients were included (21 male; 84%), mean age 67.8 (range: 51‐81). Prior stroke was reported in 18 patients (72%) and TIA in in 13 (52%). Fourteen patients’ occlusion was at the level of the bifurcation (56%), nine at the cervical level (36%), one at the level of the mandible (4%) and one at the level of the common carotid artery (4%). The mean follow‐up duration was 23.1 ± 38.3 months. Dual antiplatelet therapy was used in 15 patients (60%), and single‐agent therapy in eight (32%). Technical treatment success, defined as adequate recanalization of the treated artery, was achieved in 20 (80%) patients, representing 13 of 18 patients from the typical group and all seven from the atypical group. Five patients (20%) failed the endovascular revascularization attempt and were treated with EC‐IC bypass instead (all from typical group). Periprocedural complications occurred in 11 patients (44%), affecting 10 of 18 patients (56%) with typical occlusion and 1 of 7 (14%) with atypical occlusion. During follow‐up, three patients (12%) experienced ischemic stroke and, three (12%) had TIA. Functional status changed in 16 patients (64%), with improvement in 12 and decline in four. Categorically, six patients (24%) transitioned to a favorable outcome (mRS ≤2), while three (12%) shifted to an unfavorable one (two had underlying malignancies). Conclusion Endovascular revascularization offers a salvage option for patients with symptomatic CICAO who fail medical therapy. While the procedure can reduce recurrent ischemia and improve functional outcomes, it carries procedural risks, especially in cases with typical occlusion. Patients with atypical occlusions showed higher success rates and fewer complications, suggesting they may benefit most from this approach. Careful patient selection remains critical, and further studies are needed to refine indications and improve safety.
Rabih G. Tawk (Sat,) studied this question.
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