LAUSR

Introduction: Patients with medically refractory COICA (chronically occluded internal carotid artery) have an annual stroke risk of 5%-7%, can suffer from cognitive impairment, refractory hypertension, and have decreased quality of life. Methods: We reviewed the literature on interventions for COICA patients to assess the risks/benefits after recanalization via endovascular techniques (ETs) or hybrid surgery [ET plus carotid endarterectomy] (HS). Carotid occlusion was defined as 100% stenosis based on DSA. Chronicity was defined as ≥ 1 month of documented occlusion of the ICA. We used the Hasan et al grading system for COICA classification. Results: The rate of successful recanalization varied from 60-100%, and that of complications from 0-21.75%. Both rates were classification dependent: for type A and B, the successful recanalization rate using ET was 100.00% with a 5.00% complication rate. For type C, the success rate for ET was 44.44% with a complication rate of 44.44%; however, for the HS, developed to treat specifically type C, the success rate was 88.73% with a major complication rate of 5.66% and a minor complication rate of 7.04%. For type D, the success rate was 25% with a 12.5% complication rate. Successful recanalization leads to an improvement in the neurological symptoms with control of the recurrent ischemic symptoms in 88.0%. Failure to recanalize lead to recurrent T.I.As/strokes 30 days post-procedure in 40% of the patients. Successful recanalization leads to a reversal of systolic hypertension, which was maintained at follow-up in 85.71% (23/27) patients. Bradycardia occurred in 62% (36/69) of ET of COICA, and in 0% of HS, and was classification dependent: 90% of type A, 80% of type B, 44% of type C and 44% of type D. Successful recanalization resulted in symmetrical perfusion between the 2 hemispheres, resolution of penumbra, normalization of the MTT and improvement in MoCA score. Conclusion: Type A and B benefited from ET. Type C can benefit from HS. Type D did not benefit from any intervention. A phase 2b randomized controlled trial is needed