To explore the safety and feasibility of endovascular treatment (EVT) to recanalize the intracranial segment of internal carotid artery (ICA) under the guidance of dual-roadmap in patients with symptomatic non-acute internal carotid artery occlusion (SNA-ICAO) for more than 24 hours.

Patients with SNA-ICAO who received endovascular recanalization treatment under the guidance of dual-roadmap in the First Affiliated Hospital of Xi'an Jiaotong University and the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from January 2020 to August 2023 were retrospectively included. Demographic and clinical data, including baseline data, imaging results, surgical indicators, clinical outcomes and follow-up data, were collected and a descriptive analysis of the above data was carried out to comprehensively evaluate the safety and effectiveness of this technique for such patients.

A total of 32 patients were included. Vascular recanalization was successful in 30 cases (93.75%). Thrombus escape occurred in only one case (3.1%) and vascular dissection occurred in three cases (9.4%), without any vascular perforation or hemorrhage. Hyperperfusion syndrome occurred in four patients (12.5%), of which only 1 patient (3.1%) had symptomatic intracranial hemorrhage within 24 hours after surgery. There were 26 patients completing the imaging follow-up at 12 months postoperatively, of which 4 cases had restenosis of the stent (15.4%). After 90 days, 28 cases (93.3%) had favorable prognosis. Patients with either type I or type II occlusion had a high rate of successful recanalization and a favorable prognosis.

For patients with SNA-ICAO, EVT under the guidance of dual-roadmap technique is safe and effective.