Abstract 098: Endovascular Treatment of Symptomatic Bilateral Carotid Artery Occlusions

Introduction The annual incidence of acute ischemic strokes or transient ischemic attacks due to chronic carotid occlusion (CCO) is estimated at 5‐10%. While initial trials did not show a clear benefit for surgical treatment of symptomatic CCO, emerging data suggests that endovascular treatment (EVT) may offer significant advantages over best medical management (BMM) in selected cases. However, the use of EVT for bilateral symptomatic CCO has not been previously investigated. Method We present the case of a 67‐year‐old male with a history of oropharyngeal carcinoma, treated with extensive neck radiation, leading to bilateral common carotid artery occlusions. The patient, initially presenting for elective gastric endoscopy, experienced hypotension during anesthesia induction and subsequently became comatose. Imaging revealed complete occlusion of the bilateral common carotid arteries and the right vertebral artery, with CT perfusion showing extensive global hypoperfusion correlating with severe EEG attenuation. Due to the failure of medical management, EVT was deemed necessary. Results A femoral approach was utilized for endovascular access to each common carotid artery. The procedure involved the use of a guide catheter, microwires for crossing occlusions, and multiple angioplasties with various balloon sizes to create a passage through the occlusions. An embolic protection device was employed to prevent iatrogenic distal embolization. Rheolytic thrombectomy aided in recanalization, followed by the placement of several stents in a telescopic fashion to achieve vessel patency. Intravascular ultrasound (IVUS) was performed pre‐ and post‐recanalization to evaluate vessel integrity. The procedure resulted in the complete recanalization of both carotid arteries, with subsequent resolution of perfusion abnormalities and normalization of electroencephalographic patterns. The patient returned to his neurological baseline within days post‐procedure. Conclusion This case demonstrates the safe and effective use of EVT for the treatment of bilateral chronic carotid artery occlusions. It highlights the potential of EVT as a promising therapeutic option in managing CCO, particularly in cases where medical management fails.