To investigate the safety, feasibility, and clinical efficacy of recanalization of chronic symptomatic internal carotid artery occlusion.

The clinical data of 12 patients with chronic symptomatic internal carotid artery occlusion who underwent endovascular therapy or hybrid surgery from January 2019 to December 2020 in the Neurosurgery department of Suzhou Municipal Hospital were retrospectively analyzed and summarized.

Ten patients were treated with endovascular therapy, and another two patients were treated with hybrid surgery. Among them, ten patients were successfully recanalized, and the other two patients failed to recanalize. CT angiography (CTA) of the ten patients who were successfully recanalized before the discharge showed that the blood vessels were unobstructed. CT perfusion imaging（CTP）showed that the cerebral blood volume, cerebral blood flow, average transit time, and peak time of the patients were improved to some extent compared with themselves before surgery. Still, they did not completely return to normal. Among the ten patients who were successfully recanalized during the follow-up, six patients' clinical symptoms improved, and the other four patients' clinical symptoms did not change significantly. The clinical symptoms of two patients with failed patency were similar to those before the operation. Among the patients who were recanalized, one patient stopped using dual antiplatelet therapy on his own. Three months after the operation, CTA showed that the internal carotid artery on the operative side was re-occluded. During follow-up, CTA of two patients found a certain degree of restenosis (≤50%). Among the patients who failed, one patient had iatrogenic carotid cavernous fistula. Six months after follow-up, digital subtraction angiography of the brain showed that the fistula was occluded.

It is feasible to treat symptomatic patients with chronic internal carotid artery occlusion with endovascular therapy or hybrid surgery under the premise of clear surgical indications, with high safety and significant efficacy.