A Proposed Modern Standardized Technical Approach for Symptomatic Chronic Carotid Total Occlusion Management

Overview

Journal Interv Neuroradiol

Publisher Sage Publications

Specialty Neurology

Date 2024 Jan 3

PMID 38166519

Authors

Razvan Alexandru Radu

Federico Cagnazzo

Adrien Ter Schiphorst

Paolo Machi

Cyril Dargazanli

Pierre-Henri Lefevre

Gregory Gascou

Vincent Costalat

Affiliations

Soon will be listed here.

Abstract

Chronic carotid total occlusion (CCTO) is a known cause of ischemic stroke and transient ischemic attack. Symptomatic CCTO is associated with up to 30% risk of recurrent ischemic stroke, despite optimal medical treatment. Notably, a randomized controlled trial reported that previous surgical management did not improve the overall prognosis of these patients. Endovascular treatment of CCTO has been proposed as a feasible strategy to re-establish cerebral perfusion in symptomatic patients. However, its use is controversial and not supported by evidence from randomized clinical trials. Recently, a meta-analysis reported a reasonably high procedural success without an excess periprocedural complication rate, but several steps are needed before the procedure is mature enough to be tested in randomized controlled trials. This review highlights the developments in the endovascular recanalization of CCTO and emphasizes key steps towards standardizing the procedure.

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