Mid- to long-term outcomes of different treatment strategies for chronic carotid artery occlusion: a single-center cohort study.

Chronic internal carotid artery occlusion (CICAO) is a significant cause of ischemic cerebrovascular events, with an annual stroke risk of up to 20%. Although the long-term efficacy of hybrid surgical revascularization (HSR) versus conservative medical therapy (CMT) remains controversial, preliminary studies suggest HSR may improve cognitive function. This study aimed to evaluate the long-term efficacy and safety of HSR versus CMT in CICAO patients and explore prognostic factors. A retrospective analysis included 62 CICAO patients (37 HSR, 25 CMT) from Beijing Tiantan Hospital (2016-2019), with a mean follow-up of 81 months. The HSR group underwent carotid endarterectomy combined with endovascular therapy, while the CMT group received standardized antiplatelet and lipid-lowering therapy. The primary endpoint was recurrent cerebral infarction, and the secondary endpoint was mortality. Kaplan-Meier survival analysis and multivariable Cox regression models were used for exploratory efficacy assessment. Given the limited sample size and the non-randomized treatment allocation, propensity score matching was not performed; instead, treatment allocation and baseline imbalance were explicitly described and the findings were interpreted with caution. The HSR group showed a lower annual recurrent infarction rate than the CMT group (3.6% vs. 7.6%, p = 0.025), whereas the apparent mortality difference was not supported by adjusted analysis because no death events occurred in the HSR group and the mortality model was unstable. Subgroup analysis showed heterogeneity according to angiographic recanalization status. In survival analysis, HSR was associated with a numerically lower risk of recurrent infarction, but the association did not reach statistical significance after adjustment (adjusted HR 0.49, p = 0.16). In this single-center retrospective cohort, HSR was associated with a lower crude rate of recurrent cerebral infarction during long-term follow-up, but the adjusted analyses did not confirm a statistically robust reduction in recurrent infarction or mortality. These findings should therefore be interpreted as hypothesis-generating. Hemodynamic improvement rather than complete anatomical recanalization may be relevant to outcome, and larger prospective studies are required for confirmation.