Hybrid surgery for chronic symptomatic occlusion of the internal carotid artery: an analysis of 9 cases

Objective To investigate the feasibility and safety of hybrid surgery in treatment of chronic symptomatic internal carotid artery occlusion. Methods From April 2016 to December 2018, 9 patients with chronic symptomatic internal carotid artery occlusion confirmed by digital subtraction angiography were treated with carotid endarterectomy (CEA)+ double chamber Fogarty balloon (3F) embolectomy or stent implantation when necessary. The clinical data of these patients were retrospectively analyzed. Vascular recanalization and complications during perioperative period and follow-up of the patients were analyzed. Results CEA+double chamber Fogarty balloon (3F) thrombectomy was performed in 5 patients; and stent placement was performed in 4 patients after Fogarty balloon thrombectomy. The internal carotid arteries of all 9 patients were unobstructed immediately during the operation. Postoperative hyperperfusion syndrome occurred in 3 patients; blood pressure was strictly controlled and the symptoms gradually relieved after proper dehydration. No serious complications such as cerebral hemorrhage, cerebral infarction, or nerve injury occurred. The duration of follow-up was 4-36 months; no patient developed a new stroke or death; no re-occlusion appeared; but one mild restenosis (50%) was detected. one patient suffered from a TIA attack 6 months after operation. Conclusion Hybrid surgery is an effective method for treatment of chronic symptomatic internal carotid artery occlusion; however, preoperative evaluation and selection of patients should be carefully; individualized treatment plans should be developed. Key words: Internal carotid artery occlusion; Hybrid surgery; Endarterectomy; Fogarty catheter embolectomy; Carotid artery stenting