title: Hybrid surgery for symptomatic chronic total occlusion of carotid artery: a technical note.
abstract: BACKGROUND
  Although medical treatment has been considered a dogma for chronic total occlusion (CTO) of the carotid artery, use of endovascular recanalization has also been reported. However, there are some difficulties in performing endovascular recanalization. We present the novel technical details and advantages of hybrid surgery for recanalization of symptomatic CTO of the internal carotid artery (ICA).
  
  
  METHODS
  Three cases with recurrent ischemic attacks due to thrombotic occlusion of the right ICA above the bifurcation were successfully treated by this hybrid surgery, combining endarterectomy of the proximal ICA with endovascular angioplasty of the distal ICA. Using this hybrid technique, complete recanalization was achieved in all 3 cases. Follow-up computed tomography angiography with perfusion imaging showed improved brain perfusion. At 6-month follow-up, ischemic symptoms had not recurred.
  
  
  CONCLUSIONS
  We consider this hybrid surgery to be a feasible and good alternative surgical procedure for the treatment of CTO of the internal carotid artery.
authors.affiliation: Departments of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Yu-Tung
authors.initials: YT
authors.lastname: Shih
authors.forename: Wen-Hsien
authors.initials: WH
authors.lastname: Chen
authors.forename: Wen-Lieng
authors.initials: WL
authors.lastname: Lee
authors.forename: Hsu-Tung
authors.initials: HT
authors.lastname: Lee
authors.forename: Chiung-Chyi
authors.initials: CC
authors.lastname: Shen
authors.forename: Yuang-Seng
authors.initials: YS
authors.lastname: Tsuei
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D002908:Chronic Disease; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome