A Novel Endovascular Technique for Recanalization of Carotid Artery Chronic Total Occlusion: Staged Carotid Angioplasty and Stenting

Abstract Aim Symptomatic carotid artery chronic total occlusion (SCACTO) can lead to neurocognitive function decline and carries a high risk or recurrent stroke. The treatment option is limited, endovascular intervention may be an alternative treatment but still controversial. To our knowledge, the staged carotid angioplasty and stenting (SCAS) did not previously reported. The purpose of this study was to report our experiences in this novel technique. Methods In 2017–2018, we attempted the staged carotid angioplasty and stenting (SCAS) approach in 13 patients who received SCACTO treatment. The SCAS approach involves two stages of intervention. The first stage involves initial recanalization and initial small-sized balloon angioplasty. The second stage, which is performed 4–6 weeks later, involves angioplasty and carotid stent placement. Results The success rate of SCAS was 76.9%. At the second stage, the lumen remained patent in all the patients. The mean spontaneous increase in lumen diameter after 4–6 weeks was 51.7%. The median length of the stent was 4.0 cm, and the median number of stents used was 1. One patient had a complication of dissection, with a complication rate of 7.6%. Conclusions SCAS is a novel technique in the endovascular treatment of SCACTO. It is a feasible and safe approach that could reduce the complication rate and number of carotid stents needed.