Introduction: Most cases with chronic total occlusion of carotid artery can be compensated with collateral flow. Some cases with insufficient collateral flow are a difficult situation. Even EC-IC bypass surgery can solve a part of those cases but it is not high flow enough for those patients. Direct endovascular angioplasty for total occlusion of carotid artery was reported by few reports with lower successful rate and potential high morbidity.
Methods: We described three cases of chronic total occlusion of carotid artery with repetitive transient ischemia accident (TIA) treated successfully by combination of endarterectomy of carotid bifurcation and endovascular angioplasty of distal internal carotid artery (ICA)
Results: All cases were recanalized successufully using this hybrid technique, combining endarterectomy and endovascular angioplasty. CT perfusion scan showed improved median transit time (MTT) and cerebral blow flow (CBF). The patients recovered well after this hybrid surgery.
Conclusions: We consider the hybrid surgery, combining endarterectomy and
endovascular angioplasty of distal ICA is a reasonable and safe surgical procedure to treat those total occlusion cases need to be treated.
Patient Care: Sum benefits from carotid endarterectomy and carotid artery stent
Minus deficits from CAE and CAS
Learning Objectives: Hybrid operation decreases peri-operative morbidity and improves outcome in high level ICA occlusion and low cerebral perfusion TIAs.