Abstract Body: Background: Chronic total internal carotid artery occlusion (CTO) can be associated with a high (22-25%) annual risk of stroke with limited therapeutic options. Total endovascular reconstruction (TER) is increasingly feasible but mid-term and long-term outcomes have not been reported.

Methods: Data from all patients treated with carotid CTO treated with TER over the past 18years were collected in a database. Patients were selected based on the presence of angiographically proven symptomatic carotid occlusion, adequate landing zone and concurrent impairment of cerebrovascular reserve or recurrent ischemia despite maximal medical therapy. They were treated via a femoral approach using conventional CTO techniques with balloon expandable and/or self-expanding stents. Neurological evaluation of NIHSS, mRankin and carotid U/S were performed at discharge, 30days, and all subsequent follow-up. All TIA, stroke, death, and MI were recorded during follow-up. Angiographic follow-up was performed between 6-12months when possible.

Results: Twenty-six symptomatic patients with a mean age of 65±7.8years were treated. Technical success was achieved in 22/26 (85%) on first attempt and in 3/4 on second attempt for total success rate of 25/26(96%). Total 30-day stroke/death/MI was 6.9% (2 ICH, both in first 3 years of experience). There were no recurrent events during 15.2±9.8months (median 12) of follow-up. Restenosis was found in 5/26 (19.2%) of patients; 2/5 were in unstented segments of the ICA. There was one case of asymptomatic carotid occlusion at 7months. The median mRS dropped from 2 to 1 at follow-up.

Conclusion: TER is feasible in most patients with carotid CTO and is associated with a 30-day event rate lower than reported for STA-MCA bypass surgery. It is associated with good long-term stroke reduction despite a 19.2% risk of restenosis. Carotid re-occlusion is rare. Randomized trials are needed to validate this approach.