Novel Treatment: Intradural Chronic Total Occlusion and Endovascular Therapy
With each passing year, minimally invasive surgery becomes the norm for more and more surgical procedures. Endovascular surgery (or Endovascular Therapy: EVT) is one such category, wherein surgeons thread catheters through small incisions into vessels to perform a variety of repairs such as clot removal and other flow restoration procedures.1
But when the phrase “flow restoration” is used, one company comes to cerebrovascular clinician’s minds: Transonic.
Our devices have been essential partners in open cerebrovascular surgeries for decades, to the extent that our users report our devices prompting graft revision in 1/3 of their cases. Without our device, that’s 1 in 3 patients who would leave the OR with graft flow that the surgeon would have considered unacceptable if they had been aware.
A novel flow-restoration therapy was recently discussed at the 2025 European Society of Minimally Invasive Neurological Therapy. Petra Cimflová (University Hospital of Bern, Bern, Switzerland) gave a presentation detailing the results of the Re-CHILL study, which retrospectively reviewed symptomatic intradural chronic total occlusions (CTO’s) of the internal carotid, middle cerebral, vertebral or basilar arteries. The goal was to review the viability and outcomes of EVT in these cases, though only a handful of hospitals have attempted this procedure to date.
Endovascular therapy is frequently used to treat extradural/cervical CTO’s, protocols being well-established. Intradural use of the procedure is considerably more complicated for several reasons, including increased likelihood of distal embolism and the “snowplough effect,” that is, the tendency of deformed arterial plaques to obstruct perforators.
In her presentation, Cimflová described the study in detail, with n=25 cases from half a dozen hospitals. Median age was 65 years with nearly ¾ of the cases having history of stroke or transient ischemic attack.
Early outcomes were promising. Of the 25 patients, 17 improved clinically, 5 remained unchanged, and 3 worsened within the first 10 days. Cimflová dutifully noted that when the outcomes were poor, they were extremely so, but the overall improvement in the majority of patients suggests excellent potential for the future. The Re-Chill study is ongoing, collecting more data for further use.2
We applaud the researchers in their efforts, and we eagerly await the next developments in not only cerebrovascular surgery, but every field in which our devices are used.
Transonic Systems, Inc
The Measure of Better Results
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