Carotid artery stenting under proximal balloon protection via the transbrachial approach using a balloon guiding catheter: sheathless method with 9Fr Optimo

Abstract

Objective: Proximal balloon protection (PBP) in carotid artery stenting via the transbrachial carotid artery stenting (TB-CAS) approach has not been feasible because a large-sized sheath introducer is required. We report a novel technique of TB-CAS using sheathless balloon guiding catheter navigation. Case presentation: A 76-year-old male presented with a symptomatic left internal carotid artery stenosis. Transfemoral approach was difficult because of severe arteriosclerosis obliterans. A 9Fr Optimo 90 cm was inserted into the right brachial artery over a 6Fr long dilator 108 cm by the coaxial method without sheath introducer, and it was advanced into the right subclavian artery. A long dilator was exchanged with an inner catheter and a 9Fr Optimo was navigated into the common carotid artery by using the telescoping technique. Further procedures were successfully performed by PBP using a 9Fr Optimo. The patient's postoperative course was uneventful, and follow-up head MRI did not reveal any distal embolization. Conclusion: This technique is useful in high-risk patients of distal thromboembolic complication in CAS with difficult femoral access, because it enables PBP by TB-CAS.

Distal Transradial Approach in Mechanical Thrombectomy: Technical Note

“… 10) It was recently suggested that the use of a balloon guiding catheter (BGC) improves the recanalization rate, 12) but they are difficult to use in dTRA. To use a BGC in the current MT through dTRA, one with a thin diameter may be used with a thin BGC and stent retriever 13) or a sheathless BGC with a wide diameter.. 14) In the former, an aspiration catheter cannot be concomitantly used when it is necessary, whereas in the latter, even though it is used sheathlessly, applicable cases are limited because the outer diameter of the BGC is large (outer diameter of a 9Fr BGC is approximately 3.0 mm 14) ) in consideration of the mean vascular diameter of the deep palmar br. Therefore, the use of a guiding catheter is limited, being the weakest point of MT through dTRA.…”

Alternative Proximal Protection Method during Carotid Artery Stenting Using Combined Transbrachial and Transradial Artery Approaches

“…To reduce puncture site complications as much as possible, BGC was inserted using a 5-Fr long dilator into the brachial artery without a sheath. Koge et al 9) reported a case in which a BGC was safely guided into the CCA without the need for a sheath, using a dedicated 6-Fr long dilator in combination with a 9-Fr BGC. However, in the cardiovascular field, bleeding complications at the puncture site were observed in 2.3% of patients using the transbrachial approach, 10) which is higher than the rate of 2.0% 10) seen when using the transfemoral approach.…”

Mechanical Thrombectomy for Azygos Anterior Cerebral Artery Occlusion: A Case Report and Literature Review

“…Hence, we switched to a right brachial artery approach. We directly introduced a 9Fr OPTIMO into the right brachial artery with a sheath-less method 9) using a 6Fr long dilator, and easily navigated the OPTIMO into the left ICA ( Fig. 1E ).…”