Transcervical Approach With Protective Flow Reversal for Carotid Angioplasty and Stenting

2005 ◽  
Vol 12 (4) ◽  
pp. 446-453 ◽  
Author(s):  
Iraklis I. Pipinos ◽  
Jason M. Johanning ◽  
Chinh N. Pham ◽  
Krishnasamy Soundararajan ◽  
Thomas G. Lynch
Keyword(s):  
Flow Reversal ◽  
Carotid Angioplasty ◽  
Transcervical Approach ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Transcervical Carotid Stenting with Flow Reversal for Neuroprotection: Technique, Results, Advantages, and Limitations

Vascular ◽  
2006 ◽  
Vol 14 (5) ◽  
pp. 245-255 ◽  
Author(s):  
Iraklis I. Pipinos ◽  
Matias Bruzoni ◽  
Jason M. Johanning ◽  
G. Matthew Longo ◽  
Thomas G. Lynch
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Flow Reversal ◽  
Transcervical Approach ◽  
Weighted Magnetic Resonance Imaging ◽  
Carotid Occlusive Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Carotid angioplasty and stenting are progressively earning a role as a less invasive alternative in the treatment of carotid occlusive disease. The most common approach for carotid artery stenting involves transfemoral access and use of a filter or balloon device for neuroprotection. This approach has limitations related to both the site of access and the method of neuroprotection. Specifically, an aortoiliac segment with advanced occlusive or aneurysmal disease or an anatomically unfavorable or atheromatous arch and arch branches can significantly limit the safety of the retrograde transfemoral pathway to the carotid bifurcation. Additionally, data provided by the use of transcranial Doppler monitoring and diffusion-weighted magnetic resonance imaging in patients undergoing filter- or balloon-protected carotid artery stenting demonstrate that currently available devices are associated with a considerable incidence of cerebral embolization. To address these limitations, we, along with others, have employed a direct transcervical approach for carotid artery stenting that incorporates the principle of flow reversal for neuroprotection. The technique bypasses all of the anatomic limitations of transfemoral access and simplifies the application of flow reversal, which is one of the safest neuroprotection techniques. The purpose of this review is to describe our method of transcervical carotid artery stenting, review the accumulating outcomes data, and discuss the clinical advantages of and indications for this increasingly popular technique.

scholarly journals Safety and Efficacy of Flow Reversal in Acute and Elective Carotid Angioplasty and Stenting Using the Mo.Ma Device with Short-Term Follow-Up

2019 ◽  
Vol 8 (2-6) ◽  
pp. 196-205
Author(s):  
Ambooj Tiwari ◽  
Ryan Bo ◽  
Keithan Sivakumar ◽  
Karthikeyan M. Arcot ◽  
Philip Ye ◽  
...  
Keyword(s):  
Flow Reversal ◽  
Carotid Angioplasty ◽  
Short Term ◽  
Safety And Efficacy ◽  
Carotid Revascularization ◽  
Subacute Stroke ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
Radiographic Data

Objective: To determine the safety and efficacy of flow reversal following proximal flow arrest as an embolic protection strategy for carotid angioplasty and stenting (CAS) with short-term follow-up. Method: We performed a retrospective review of our CAS database for patients who underwent stent-supported carotid revascularization in the setting of acute/subacute stroke or TIA. We reviewed clinical and radiographic data during a 36-month period. Primary outcome was clinical evidence of ipsilateral stroke in the first 30 days. Secondary outcomes include clinical outcomes and sonographic and/or angiographic follow-up over 6 months, 6-month functional scale, and all-cause mortality. Results: Fifty-five patients underwent CAS using flow reversal: 26 females and 29 males with a mean age of 69.7 years. Median time to treatment from index event was 3 days. 11% underwent stenting as part of hyperacute stroke therapy. Average luminal stenosis was 86%. The 9-Fr Mo.Ma device was used in combination with Penumbra aspiration in all cases. There were no ipsilateral strokes. Incidence of any ischemic event was 3.64%, but only 1 (1.82%) patient had a postoperative stroke. Clinical follow-up was available for 94.5%, while lesion follow-up was available for 73% of patients. Three patients had evidence of restenosis, but none were symptomatic. Luminal restenosis was ≤30% in all three. Median pre- and post-NIHSS were 1 and 1, respectively. Conclusion: Flow reversal using the Mo.Ma device is a safe and effective strategy in preventing distal embolization during carotid artery revascularization.

One Patent Intracranial Collateral Predicts Tolerance of Flow Reversal during Carotid Angioplasty and Stenting

2009 ◽  
Vol 23 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Iraklis I. Pipinos ◽  
George T. Pisimisis ◽  
Sathyaprasad C. Burjonrappa ◽  
Jason M. Johanning ◽  
G. Matthew Longo ◽  
...  
Keyword(s):  
Flow Reversal ◽  
Carotid Angioplasty ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

scholarly journals SS31. Diabetes is Not a Predictor of Adverse Outcome after Carotid Revascularization with Carotid Angioplasty and Stenting (CAS)

2011 ◽  
Vol 53 (6) ◽  
pp. 102S-103S
Author(s):  
Paola De Rango ◽  
Enrico Cieri ◽  
Gianbattista Parlani ◽  
Fabio Verzini ◽  
Gioele Simonte ◽  
...  
Keyword(s):  
Adverse Outcome ◽  
Carotid Angioplasty ◽  
Carotid Revascularization ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting
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