Carotid Stenting: Flow Reversal Technique: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ricardo A Domingo ◽  
Krishnan Ravindran ◽  
Rabih G Tawk ◽  
Adam Arthur ◽  
Mark Bain ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Hybrid Approach ◽  
Carotid Stenting ◽  
Flow Reversal ◽  
Direct Access ◽  
Cranial Neuropathy ◽  
Management Options

Abstract Management options for carotid stenosis include medical management, carotid endarterectomy, carotid stenting with distal filter protection, or stenting with either flow arrest or flow reversal techniques.1 Flow reversal with transcarotid artery revascularization (TCAR) technique represents a hybrid approach with surgical access to the common carotid for endovascular placement of a stent in the internal carotid artery. This direct access to the carotid artery avoids navigating the challenging anatomy of the aortic arch with endovascular devices.2 Compared to transfemoral stenting, TCAR possesses lower risk of transient ischemic attack and stroke, and compared to carotid endarterectomy, there is less risk of cranial neuropathy.3,4  We present the case of an 87-yr-old man with recurrent severe stenosis (85%) of the right internal carotid artery. The patient had a remote history of bilateral endarterectomies for asymptomatic stenosis and was found with recurrence and progression of right internal carotid artery stenosis. Options were discussed and decision was made to proceed with TCAR after he consented for the procedure. The patient tolerated the procedure well with satisfactory revascularization. Exam remained unremarkable prior to discharge on postoperative day 1 and during follow-up at 1 mo. Patient consented to the publication of their image.

Endovascular Treatment for Pseudo-occlusion of the Internal Carotid Artery

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 301-309 ◽  
Author(s):  
Tomoaki Terada ◽  
Mitsuharu Tsuura ◽  
Hiroyuki Matsumoto ◽  
Osamu Masuo ◽  
Tomoyuki Tsumoto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Perioperative Complications ◽  
Carotid Stenting ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Embolic Protection

Abstract OBJECTIVE: The surgical benefit to pseudo-occlusion of the internal carotid artery (ICA) is controversial. Because the benefit of carotid endarterectomy for pseudo-occlusion of the ICA remains uncertain, we examined the use of carotid stenting as a possible alternative treatment for this condition. METHODS: Twenty cases of carotid pseudo-occlusion (17 symptomatic, three asymptomatic) were treated with carotid artery stenting. Nineteen patients were treated with various embolic protection techniques. Our clinical results, including angiographic follow-up data, perioperative complications, and data on the effectiveness of the embolic protection methods were studied for ICA pseudo-occlusion. RESULTS: All pseudo-occlusions were successfully dilated, and the stenotic ratio was reduced from 95 to 6.7% on average. No neurological deterioration was encountered in any of the cases, although one patient died of cardiac event 1 day after treatment. None of the patients experienced stroke during the mean 24.8 month follow-up period, although one patient died from myocardial infarction. Among the 17 cases in which follow-up angiography was performed at 6 months after stenting, only one patient demonstrated restenosis. This patient was successfully treated with repeated percutaneous transluminal angioplasty. The rate of restenosis in our series was 5.9%, and the morbidity/mortality rate within 30 days was 5%. CONCLUSION: The clinical results of carotid stenting for ICA pseudo-occlusion under embolic protection were fairly good from the viewpoints of periprocedural neurological morbidity, angiographic follow-up results, and stroke prevention. Carotid stenting can be considered an alternative to carotid endarterectomy in patients with ICA pseudo-occlusion.

scholarly journals Staged Carotid Stenting and Carotid Endarterectomy for Bilateral Internal Carotid Artery Stenosis

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 143-148 ◽  
Author(s):  
H. Fukuda ◽  
K. Iihara ◽  
N. Sakai ◽  
K. Murao ◽  
H. Sakai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Complication Rate ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Carotid Stenting ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Minor Stroke

The purpose of this study was to evaluate the efficacy and safety of staged carotid stenting (CS) and carotid endarterectomy (CEA) for bilateral internal carotid artery stenosis. With this strategy, initial carotid stenting was performed for the high grade carotid stenosis to reduce the risk of subsequent CEA. Eight patients were treated with staged CS and CEA; CS for asymptomatic side followed by CEA for symptomatic side. Sufficient revascularization was obtained in all procedures but one CS procedure. Two minor stroke caused by distal embolism occurred during the perioperative period of CS. Postprocedural persistent hypotension was observed in one CS procedure. The mean interval between CS and CEA was 19.8 days. In conclusion, although our strategy has some advantages such as avoidance of bilateral cranial nerve palsy and shorter admission period over staged CEA, relatively high complication rate was noted at the first CS without any stroke morbidity post CEA. Our preliminary result showed that further reduction of periprocedural complication rate at the initial stenting is mandatory for this approach justified.

Intracranial dissection during carotid endarterectomy treated by carotid stenting

VASA ◽  
2009 ◽  
Vol 38 (1) ◽  
pp. 81-84 ◽  
Author(s):  
Attigah ◽  
Ganten ◽  
Hyhlik-Dürr ◽  
Kotelis ◽  
Geisbüsch ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Cerebral Perfusion ◽  
Internal Carotid ◽  
Fatal Outcome ◽  
Carotid Stenting ◽  
Thrombotic Occlusion ◽  
Completion Angiography ◽  
Intracranial Dissection

Intracranial dissection of the internal carotid artery after carotid endarterectomy (CEA) is a serious complication with a potentially fatal outcome. We report on a 67 male with a symptomatic high grad stenosis of the internal carotid artery. Intraoperative completion angiography showed a thrombotic occlusion and the internal carotid artery (ICA) was resected with interposition of a Dacron graft. Completion angiography then revealed a dissection of the petreous ICA, which was corrected by insertion of a coronary artery stent.Stenting of the ICA is a useful tool to restore cerebral perfusion without time delay and completion imaging is extremely helpful for early detection of dissection during CEA.

scholarly journals Transcervical carotid stenting with internal carotid artery flow reversal: Feasibility and preliminary results

2004 ◽  
Vol 40 (3) ◽  
pp. 476-483 ◽  
Author(s):  
Enrique Criado ◽  
Manuel Doblas ◽  
Juan Fontcuberta ◽  
Antonio Orgaz ◽  
Angel Flores ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Stenting ◽  
Flow Reversal ◽  
Preliminary Results ◽  
Artery Flow

scholarly journals Successful application of left radial access for stenting the right internal carotid artery in a patient with multifocal atherosclerosis: A case report

2019 ◽  
Vol 23 (2) ◽  
pp. 80 ◽  
Author(s):  
R. R. Khafizov ◽  
T. N. Khafizov ◽  
I. A. Idrisov ◽  
E. E. Abkhalikova
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Conflict Of Interest ◽  
Internal Carotid ◽  
Carotid Stenting ◽  
Radial Access ◽  
Transradial Access ◽  
The Right ◽  
Brachiocephalic Arteries

<p>This article presents a successful clinical case of the endovascular treatment of stenosis of the right internal carotid artery through the left radial access in a patient with multifocal atherosclerosis with the occlusion of both iliac arteries and the right radial artery. Transfemoral access is the conventional access route for carotid stenting. However, this may be problematic because of peripheral vascular disease and numerous anatomical variations of the aortic arch and cervical arteries. Bleeding in the puncture area is the most common complication after carotid artery stenting (CAS) via transfemoral access. The elimination of such complications has been well demonstrated via transradial access in patients undergoing coronary interventions. Thus, transradial access has been evaluated as an alternative strategy for carotid stenting. Currently, the CAS procedure is a fairly routine practice in many centres involved in the treatment of this pathology; however, a small percentage of patients who are contraindicated in carotid endarterectomy who lack standard puncture access to the arteries and have a complex anatomy of the brachiocephalic arteries still remain. In such cases, the question regarding the feasibility of the CAS procedure using non-standard puncture approaches and various techniques for the catheterisation of the brachiocephalic arteries remains relevant. In this case, the left radial access and the Catheter Looping and Retrograde Engagement Technique were used for the catheterisation of the right common carotid artery because of the anatomical features, the patient’s refusal toward carotid endarterectomy, and the lack of standard access (femoral and right radial). A distal protection system was used for the brain.</p><p>Received 18 July 2019. Revised 15 August 2019. Accepted 19 August 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Operator: R.R. Khafizov <br />Collection and processing of material: R.R. Khafizov, I.A. Idrisov<br />Writing original draft: R.R. Khafizov<br />Editing: E.E. Abkhalikova, T.N. Khafizov</p>

Hybrid Repair of a Common Carotid Pseudoaneurysm and Concomitant Internal Carotid Stenosis With Retrograde Stenting and Carotid Endarterectomy

2021 ◽  
pp. 153857442199293
Author(s):  
Constantinos Zarmakoupis ◽  
George Galyfos ◽  
Grigorios Tsoukalos ◽  
Panagiota Dalla ◽  
Alexandra Triantafyllou ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Covered Stent ◽  
Hybrid Technique ◽  
Hybrid Repair ◽  
Ica Stenosis

This report aims to present a rare case of a common carotid artery (CCA) pseudoaneurysm with a concomitant internal carotid artery (ICA) stenosis that were treated with a hybrid technique. This strategy included the retrograde placement of a CCA covered stent under ICA clamping followed by standardized carotid endarterectomy. The technique will be discussed and compared with other possible treatments.

Contralateral Internal Carotid Artery Occlusion Impairs Early But Not 30-Day Stroke Rate Following Carotid Endarterectomy

Angiology ◽  
2010 ◽  
Vol 61 (7) ◽  
pp. 705-710 ◽  
Author(s):  
Erik Bagaev ◽  
A. Maximilian Pichlmaier ◽  
Theodosios Bisdas ◽  
Mathias H. Wilhelmi ◽  
Axel Haverich ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Stroke Rate ◽  
Contralateral Internal Carotid Artery

The importance of internal carotid artery occlusion tolerance test in carotid endarterectomy under locoregional anesthesia

2016 ◽  
Vol 158 (6) ◽  
pp. 1077-1081
Author(s):  
Marcos Dellaretti ◽  
Laura T. de Vasconcelos ◽  
Jules Dourado ◽  
Renata F. de Souza ◽  
Renato R. Fontoura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Tolerance Test ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Locoregional Anesthesia
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