Successful recanalization of a four-year-old long segment chronically occluded internal carotid artery (COICA) in a retrograde fashion and by a full co-axial support system.

Abstract Chronically occluded internal carotid artery, particularly refractory to the present medical and surgical treatment, carries a high risk of ischemic sequelae due to perfusion mismatch. The authors share a successful recanalization treatment detail of a symptomatic 72-year-old male patient who failed medical and surgical treatment for a chronically occluded long segment of the internal carotid artery for four years. The author focuses on the technical pearls of the novel full co-axial support system to recanalize the chronically occluded long internal carotid arterial segment.