Significance of atherosclerotic plaque location in recanalizing non-acute long-segment occlusion of the internal carotid artery

• Published in: Scientific reports 2024-05, Vol.14 (1), p.10945-10945, Article 10945
• Main Authors: Zhao, Tong-Yuan, Xu, Gang-Qin, Xue, Jiang-Yu, Bai, Wei-Xing, Cai, Dong-Yang, Yang, Bo-Wen, Shi, Wei-Yu, Li, Tian-Xiao, Gao, Bu-Lang
• Format: Article
• Language: English
• Subjects: 692/308; 692/617; 692/699; 692/700; Aged; Aged, 80 and over; Arteriosclerosis; Atherosclerosis; Atherosclerotic plaque; Cardiovascular system; Carotid arteries; Carotid artery; Carotid Artery, Internal - pathology; Carotid Artery, Internal - surgery; Carotid Stenosis - complications; Carotid Stenosis - pathology; Carotid Stenosis - surgery; Cerebral blood flow; Complications; Edema; Endarterectomy, Carotid - methods; Endovascular Procedures - methods; Female; Humanities and Social Sciences; Humans; Hybrid operation; Internal carotid artery; Ischemia; Long segment occlusion; Male; Middle Aged; multidisciplinary; Multivariate analysis; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - pathology; Plaque, Atherosclerotic - surgery; Recurrent infection; Risk Factors; Science; Science (multidisciplinary); Surgery; Treatment Outcome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-61938-y

To investigate the significance of atherosclerotic plaque location in hybrid surgery comprising both endovascular recanalization approaches and carotid endarterectomy for symptomatic atherosclerotic non-acute long-segment occlusion of the internal carotid artery (ICA), 162 patients were enrolled, including 120 (74.1%) patients in the proximal plaque group and 42 (25.9%) in the distal plaque group. Surgical recanalization was performed in all patients, with successful recanalization in 119 (99.2%) patients in the proximal and 39 (92.9%) in the distal plaque group. The total successful recanalization rate was 97.5% (158/162) with a failure rate of 2.5% (4/162). Periprocedural complications occurred in 5 (4.2% or 5/120) patients in the proximal plaque group, including neck infection in two (1.7%), recurrent nerve injury in 1 (0.8%), and laryngeal edema in 2 (1.7%), and 2 (4.8%) in the distal plaque group, including femoral puncture infection in 2 (4.8%). No severe complications occurred in either group. Univariate analysis showed plaque location was a significant ( P  = 0.018) risk factor for successful recanalization, and multivariate analysis indicated that the plaque location remained a significant independent risk factor for recanalization success ( P  = 0.017). In follow-up 6–48 months after the recanalization surgery, reocclusion occurred in two (2.8%) patients in the proximal plaque group and 4 (13.3%) in the distal plaque group. In conclusion, although hybrid surgery achieves similar outcomes in patients with ICA occlusion caused by either proximal or distal atherosclerotic plaques, plaque location may be a significant risk factor for successful recanalization of symptomatic non-acute long-segment ICA occlusion.