Introduction The benefit of revascularization of internal carotid artery (ICA) pseudo-occlusion is not defined well, and the method of revascularization is controversial. There has been no comparison between carotid endarterectomy (CEA) and carotid stent (CAS) placement for pseudo-occlusion. The purpose of this study was to evaluate the safety of CEA and CAS and compare long term imaging and clinical follow up.

Methods A retrospective database review was performed from 1/2010 to 1/2014 to identify patients who underwent carotid endarterectomy and carotid stent placement at two tertiary centers. The medical records and imaging studies of patients with ICA pseudo-occlusion were selected for analysis.

Results 24 patients met the criteria for ICA pseudo-oclcusion, and 17 patients underwent CEA while 7 patients underwent CAS. All patients had technically successful revascularization of the ICA. All patients underwent 1 month and 1 year follow up imaging. CAS patients had 14% re-stenosis and 86% vessel maturation (defined as resolution of ICA hypoplasia) rates while CEA patients had 18% with re-stenosis and 88% vessel maturation. Peri-procedure complication for CAS was 0% and CEA was 6%. There were no deaths or strokes at 1 year in any patients.

Conclusion CAS shows similar outcomes in restenosis and vessel maturation rates when compared to CEA for ICA pseudo-occlusion. There was no significant difference between the two treatments in clinical outcomes or peri-procedural complications. CAS is a revascularization option if the patient is considered high risk for CEA.

Disclosures J. Kim: None. C. Miller: None. D. Damania: None. A. Grande: None. B. Jagadeesan: None. B. Jahromi: None. R. Tummala: None.