Endovascular recanalization of chronic internal carotid artery occlusion: Clinical case and literature review

Aim. To present a clinical case of successful recanalization of chronic total internal carotid artery occlusion and results of literature review on the topic. Clinical case. The patient (55 years) with diagnosed in 2021 occlusion of the right carotid artery (from bifurcation of the common carotid artery to the ostium of the ophthalmic artery) underwent drug therapy. He was discharged from the Saint-Petersburg I. I. Dzhanelidze research institute of emergency medicine (Saint Petersburg, Russia) with complete regression of the symptoms. In 2022, after his condition worsened, computed tomography angiography showed occlusion of the internal carotid arteries on both sides. We recommended revascularization surgery which the patient declined. A course of dual antiplatelet therapy was prescribed. In 2023, after another cerebrovascular event the patient was admitted into the Institute: cerebral angiography confirmed bilateral occlusion of the left internal carotid artery up to ophthalmic arteries’ origins (type С / D per the classification by D. Hasan et al.). At the Institute, the patient underwent intravascular recanalization of chronic left internal carotid artery occlusion (29.09.2023). Control examination (cerebral angiography) 12 months later showed preserved permeability of the left carotid artery without signs of restenosis. In the absence of repeat cerebrovascular events, revascularization of the right carotid system is considered unnecessary. Literature review. A review of scientific publications on the capabilities of intravascular recanalization of chronic occlusions of the internal carotid artery is presented. Indications, techniques and results of intravascular interventions are discussed, predictors of recanalization and its complications are described. Conclusion. The development of endovascular methods allows successful recanalization of chronic and subacute occlusions of the internal carotid artery in most cases. Indications for surgery are based on the clinical features of the disease, effectiveness of drug therapy, and angiographic characteristics of the occlusion.