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Case series
Modern endovascular management of chronic total carotid artery occlusion: technical results and procedural challenges
  1. Răzvan Alexandru Radu1,2,
  2. Federico Cagnazzo1,
  3. Imad Derraz1,
  4. Cyril Dargazanli1,
  5. Francesca Rapido3,
  6. Pierre-Henri Lefevre1,
  7. Grégory Gascou1,
  8. Vincent Costalat1
  1. 1 Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
  2. 2 Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania
  3. 3 Anesthesiology and Critical Care Medicine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
  1. Correspondence to Dr Răzvan Alexandru Radu, Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France; raduarazvan{at}


Background The optimal management of chronic total carotid artery occlusion (CTO) is still debated. Endovascular treatment is being increasingly used with heterogeneous technical and clinical results.

Methods Patients with CTO treated with modern endovascular approaches during the past several years (January 2018–December 2021) were retrospectively reviewed.

Results Twenty patients, with a mean age of 63.7 years, were treated during the study period. Indications for treatment were recurrent stroke in 12 (60%), hemodynamic impairment in 4 (20%), and progressive stroke in 4 (20%) patients. In 6 (30%) patients, the occlusion was limited to the cervical portion, in 5 (25%) to the petrous segment, and in 9 (45%) to the cavernous segment. Technical treatment success was achieved in 80% of cases. In patients with successful recanalization, median pretreatment hypoperfusion volumes dropped from 126 mL (25–75 IQR, 33–224 mL) to 0 mL (25–75 IQR, 0–31.5 mL). Symptomatic procedure-related complications were 30% and permanent procedure-related morbidity-mortality was 5%. Early stent occlusion occurred in 5 (25%) cases. Two cases were asymptomatic and were not retreated, 3 cases presented transient symptoms of which two were successfully recanalized. Stent occlusion was not associated with permanent symptoms. In successfully recanalized patients no intraprocedural emboli were observed.

Conclusions In the modern endovascular era, revascularization of CTO is a feasible procedure in most cases, and it may be offered in selected patients. However, the high re-occlusion rate is still a limitation of the technique, underlining the need for more research on the technical procedural and periprocedural management.

  • Stroke
  • Atherosclerosis
  • Stenosis
  • Technique
  • Stent

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  • Contributors Study design: RAR, FC, P-HL, VC. Data collection: FR, GG, CD. Data analysis: RAR, FC, GG, ID. Drafting of the manuscript: RAR, FC, CD, FR. Revision of the manuscript: ID, FC, P-HL, VC. Project administration: VC. Supervision: VC. All authors read and agreed to the published version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.