Long-term outcomes of carotid artery stenting for carotid near-occlusion

Objective

Carotid artery near-occlusion (CANO) is an underdiagnosed condition, and the benefit of revascularizing CANO unproven. This study investigates the long-term outcomes of carotid artery stenting (CAS) in patients with CANO.

Methods

We conducted a retrospective study of patients who underwent CAS for carotid stenosis, including CANO and non-CANO groups. CANO was defined as post-stenotic narrowing of the distal internal carotid artery (ICA). The CANO group was further classified based on the presence or absence of full collapse defined as a distal ICA lumen diameter ≤ 2 mm and/or an ipsilateral-to-contralateral ICA ratio ≤ 0.42. The outcome measures included peri-procedural and long-term events, including stroke, mortality, and major adverse cerebrovascular events (MACE).

Results

123 patients with CANO and 173 patients with non-CANO carotid stenosis were retrospectively enrolled. Age and sex were comparable between groups. The CANO group had a higher proportion of patients with symptomatic lesions (36.6%) compared to the non-CANO group (25.4%), with the highest rate observed in CANO patients with full collapse (51.9%). Peri-procedural outcomes were similar between groups. There were no significant differences in long-term outcomes between the CANO and non-CANO groups, nor between CANO patients with or without full collapse. Bilateral significant ICA stenosis was a significant predictor of long-term MACE, whereas the presence of CANO or full collapse was not.

Conclusion

CAS is a viable option for patients with CANO, providing comparable long-term outcomes to those with conventional carotid stenosis. The presence of CANO with or without full collapse is not associated with worse outcomes.