Endovascular Recanalization for Nonacute Carotid Artery Occlusion: A Nationwide Registry-Based Cohort Study

BACKGROUND: The management of nonacute symptomatic internal carotid artery occlusion remains unsatisfactory. Endovascular recanalization has been reported to be feasible but associated with a noteworthy risk of postprocedural complications in patients with symptomatic internal carotid artery occlusion. The present study aimed to investigate whether successful recanalization exerts clinical benefits over procedural risks. METHODS: We analyzed consecutive patients who underwent endovascular treatment of nonacute symptomatic internal carotid artery occlusion in a nationwide prospective registry. The primary outcome was the ipsilateral ischemic stroke recurrence. Other outcomes of interest included all strokes and death during follow-up, and 30-day symptomatic intracranial hemorrhage, and all strokes after intervention. RESULTS: The final analysis included 511 patients. Endovascular revascularization was successful in 300 patients (58.7%) but failed in 211 patients (41.3%). Patients with successful recanalization had less time from the last ischemic event to the endovascular treatment as compared with patients with failed recanalization (median [interquartile range] days, 18 [12-33] versus 22 [14-50]; P=0.003). Successful recanalization was associated with a higher rate of symptomatic intracranial hemorrhage within 30 days after intervention (odds ratio [OR], 7.99 [95% CI, 1.02-62.39]; P=0.047). Thirty-day all strokes (OR, 1.91 [95% CI, 0.83- 4.40]; P=0.128) and ischemic stroke (OR, 0.90 [95% CI, 0.33-2.46]; P=0.839) did not differ significantly. During a median followup of 37 months, patients with successful recanalization demonstrated a reduced risk of ipsilateral ischemic stroke (adjusted hazard ratio, 0.28 [95% CI, 0.13-0.59]; P<0.001). The 5-year risk of all strokes and death was likewise lower in patients with successful recanalization (restricted mean survival time difference, 3.77 months [95% CI, 0.16-7.38]; P=0.041). CONCLUSION: Despite an increase in the 30-day symptomatic intracranial hemorrhage, successful recanalization was associated with reduced long-term risk of ipsilateral ischemic stroke in patients with symptomatic internal carotid artery occlusion.