{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:29:54Z","timestamp":1787891394379,"version":"build-2784847793"},"reference-count":23,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2019,12,29]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>It is debated whether endovascular treatment is indicated for a symptomatic chronically occluded internal carotid artery (COICA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess outcomes after endovascular treatment of COICA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a systematic search of three databases (PRISMA guidelines), including endovascular series of COICA. Outcomes were analyzed with random-effects models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 13 studies and 528 endovascularly treated patients with COICA. Successful recanalization was 72.6% (347\/528, 95% CI 65.4% to 79.9%, I<jats:sup>2<\/jats:sup>=68.9%). Complications were 18% (88\/516, 95% CI 12.1% to 23.8%, I<jats:sup>2<\/jats:sup>=65%), with 5% (25\/480, 95% CI 2% to 7%, I<jats:sup>2<\/jats:sup>=0%) of permanent events, and 9% (43\/516, 95% CI 6% to 13%, I<jats:sup>2<\/jats:sup>=34%) of thromboembolisms. Treatment-related mortality was 2% (11\/516, 95% CI 0.5% to 2.6%, I<jats:sup>2<\/jats:sup>=0%). Shorter duration of the occlusion was associated with higher recanalization: 80% (11\/516, 95% CI 54% to 89%, I<jats:sup>2<\/jats:sup>=0%), 63% (33\/52, 95% CI 49% to 76%, I<jats:sup>2<\/jats:sup>=0%), and 51% (18\/35, 95% CI to 37% to 88%, I<jats:sup>2<\/jats:sup>=40%) recanalization rates for 1, 3, and &gt;3 months occlusions, respectively. Complications were 6% (3\/50, 95% CI 3% to 21%, I<jats:sup>2<\/jats:sup>=0%), 14% (4\/27, 95% CI 5% to 26%, I<jats:sup>2<\/jats:sup>=0%), and 25% (13\/47, 95% CI 10% to 30%, I<jats:sup>2<\/jats:sup>=0%) for 1, 3, and &gt;3 months occlusions, respectively. Patient aged &lt;70 years presented higher revascularization rates (OR=3.1, 95% CI 1.2 to 10, I<jats:sup>2<\/jats:sup>=0%, p=0.05). Successful reperfusion was higher (OR=5.7, 95% CI 1.2 to 26, I<jats:sup>2<\/jats:sup>=60%, p=0.02) and complications were lower (OR=0.2, 95% CI 0.6 to 0.8, I<jats:sup>2<\/jats:sup>=0%, p=0.03) for lesions limited to the cervical internal carotid artery compared with the petrocavernous segment. Successful recanalization significantly lowered the rate of thromboembolisms (OR=0.2, 95% CI 0.8 to 0.6, I<jats:sup>2<\/jats:sup>=0%, p=0.01) and mortality (OR=0.5, 95% CI 0.1 to 0.9, I<jats:sup>2<\/jats:sup>=0%, p=0.04), compared with conservative treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Endovascular treatment of COICA gives a 70% rate of successful recanalization, with 5% morbidity. Patients aged &lt;70 years, lesions limited to the cervical internal carotid artery, and a shorter duration of the occlusion decreased the risk of complications. Successful recanalization of symptomatic lesions lowered by about 80% the likelihood of thromboembolisms, compared with medical management.<\/jats:p><\/jats:sec>","DOI":"10.1136\/neurintsurg-2019-015701","type":"journal-article","created":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T22:15:28Z","timestamp":1580508928000},"page":"946-951","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Endovascular recanalization of chronically occluded internal carotid artery"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3159-1678","authenticated-orcid":false,"given":"Federico","family":"Cagnazzo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6196-3869","authenticated-orcid":false,"given":"Pierre-Henri","family":"Lefevre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imad","family":"Derraz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1891-9157","authenticated-orcid":false,"given":"Cyril","family":"Dargazanli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0817-7324","authenticated-orcid":false,"given":"Gregory","family":"Gascou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Riquelme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raed","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Bonafe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Costalat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,1,31]]},"reference":[{"key":"2024111103251087000_12.10.946.1","doi-asserted-by":"publisher","DOI":"10.1177\/1538574413500539"},{"key":"2024111103251087000_12.10.946.2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2010.208330"},{"key":"2024111103251087000_12.10.946.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198511073131904"},{"key":"2024111103251087000_12.10.946.4","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.jvs.2019.06.095","article-title":"Cognitive and cerebral hemodynamic effects of endovascular recanalization of chronically occluded cervical internal carotid artery: single-center study and review of the literature","volume":"70","author":"Zanaty","year":"2019","journal-title":"J Vasc Surg"},{"key":"2024111103251087000_12.10.946.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.02.007"},{"key":"2024111103251087000_12.10.946.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.06.015"},{"key":"2024111103251087000_12.10.946.7","doi-asserted-by":"crossref","unstructured":"Hasan D , Zanaty M , Starke RM , et al . 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