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Hybrid Surgery for Symptomatic Chronic Total Occlusion of Carotid Artery: A Technical Note

Shih, Yu-Tung MD*; Chen, Wen-Hsien MD; Lee, Wen-Lieng MD, PhD§; Lee, Hsu-Tung MD*; Shen, Chiung-Chyi MD, PhD*; Tsuei, Yuang-Seng MD*

doi: 10.1227/NEU.0b013e31827fca6c
Technical Case Report

BACKGROUND AND IMPORTANCE: Although medical treatment has been considered a dogma for chronic total occlusion (CTO) of the carotid artery, use of endovascular recanalization has also been reported. However, there are some difficulties in performing endovascular recanalization. We present the novel technical details and advantages of hybrid surgery for recanalization of symptomatic CTO of the internal carotid artery (ICA).

CLINICAL PRESENTATION: Three cases with recurrent ischemic attacks due to thrombotic occlusion of the right ICA above the bifurcation were successfully treated by this hybrid surgery, combining endarterectomy of the proximal ICA with endovascular angioplasty of the distal ICA. Using this hybrid technique, complete recanalization was achieved in all 3 cases. Follow-up computed tomography angiography with perfusion imaging showed improved brain perfusion. At 6-month follow-up, ischemic symptoms had not recurred.

CONCLUSION: We consider this hybrid surgery to be a feasible and good alternative surgical procedure for the treatment of CTO of the internal carotid artery.

ABBREVIATIONS: CTA, computed tomography angiography

CTO, chronic total occlusion

EC-IC, external carotid-internal carotid

ICA, internal carotid artery

Departments of *Neurosurgery,

Radiology, and

§Cardiovascular Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

Correspondence: Yuang-Seng Tsuei, MD, Department of Neurosurgery, Taichung Veterans General Hospital, 160 Taichung-Kong Road, Sec.3 Taichung, Taiwan 40705, ROC. E-mail:

Received May 8, 2012

Accepted November 26, 2012

Copyright © by the Congress of Neurological Surgeons