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Outcomes of Multimodality In situ Recanalization in Hybrid Operating Room (MIRHOR) for symptomatic chronic internal carotid artery occlusions
  1. Wei-jian Jiang1,
  2. Ao-Fei Liu1,
  3. Wengui Yu2,
  4. Han-Cheng Qiu1,
  5. Yi-Qun Zhang1,
  6. Fang Liu1,
  7. Chen Li1,
  8. Rong Wang3,
  9. Yuan-Li Zhao3,
  10. Jin Lv1,
  11. Tian-Xiao Li4,
  12. Ce Liu1,
  13. Ji Zhou1,
  14. Ji-Zong Zhao3
  1. 1 Department of Vascular Neurosurgery, New Era Stroke Care and Research Institute, the PLA Rocket Force General Hospital, Beijing, China
  2. 2 Department of Neurology, University of California Irvine, Irvine, California, USA
  3. 3 Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University, Beijing, China
  4. 4 Department of Neurosurgery, Henan Provincial People’s Hospital and Henan Provincial Cerebrovascular Hospital, Zhengzhou University, Zhengzhou, China
  1. Correspondence to Dr Wei-jian Jiang, Department of Vascular Neurosurgery, New Era Stroke Care and Research Institute, the PLA Rocket Force General Hospital, Beijing 100088, China; jiangweijian2018{at}


Background An in situ recanalization procedure of endovascular therapy (ET) or carotid endarterectomy (CEA) has been attempted in patients with symptomatic chronic internal carotid artery occlusions (ICAOs), though the recanalization rates of both are low.

Objective To investigate the outcomes of Multimodality In situ Recanalization for ICAOs in a Hybrid Operating Room (MIRHOR) at the same session.

Methods Symptomatic chronic ICAOs were classified into type A or B (short occlusion with or without a tapered residual root [TRR]), and C or D (long occlusion with or without TRR), and managed in a hybrid operating room with ET, CEA, or both, as needed. Primary efficacy outcome was technical success of recanalization with Thrombolysis in Myocardial Infarction 3. Secondary efficacy outcome was any stroke or death within 30 days (primary safety outcome) plus an ipsilateral ischemic stroke after 30 days.

Results Technical success was finally achieved in 35 (83.3%) of 42 consecutively enrolled patients with ICAO, which was significantly higher than 35.7% (15/42, p<0.001) from the initial ET or CEA alone. Furthermore, the success rate was in descending order: 100% (18/18) for type A and B occlusions, 75% (6/8) for type C occlusions, and 69% (11/16) for type D occlusions (p=0.017). Two secondary efficacy outcome events (5.1%) without mortality, including one (2.4%) primary safety outcome, were observed during a mean follow-up of 10.5 months.

Conclusion The MIRHOR for symptomatic chronic ICAOs at the same session significantly improves technical success, with low periprocedural complications and favorable clinical outcomes. The ICAO classification appears valuable in predicting technical success.

  • angioplasty
  • atherosclerosis
  • cervical
  • intervention
  • technique

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  • W-J and J-ZZ contributed equally.

  • Contributors W-JJ and J-ZZ contributed the conception, design, data analysis, and drafted and revised the manuscript. A-FL collected and analyzed the data. WY drafted and reviewed the manuscript. H-CQ, Y-QZ, FL, ChL, RW, Y-LZ, CeL and JZ collected the data and revised the manuscript. JL and T-XL analyzed the data and revised the manuscript.

  • Funding This work was funded by National Key Basic Research Program of China (973 program) (grant No. 2013CB733805), National Natural Science Foundation of China (grant No. 81471767, 81871464). The funders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript.

  • Competing interests None declared.

  • Ethics approval the institutional ethics committee at the PLA Rocket Force General Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.