Carotid Artery Stenting With Proximal Embolic Protection via a Transradial or Transbrachial Approach

Montorsi, Piero; Galli, Stefano; Ravagnani, Paolo; Tresoldi, Simone; Teruzzi, Giovanni; Caputi, Luigi; Trabattoni, Daniela; Fabbiocchi, Franco; Calligaris, Giuseppe; Grancini, Luca; Lualdi, Alessandro; Martini, Stefano De; Bartorelli, Antonio L.

doi:10.1177/1526602816651424

Cited by 40 publications

(32 citation statements)

References 32 publications

(57 reference statements)

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“…The proximal EPD is a protection way preferred in the patients with high risk plaque (recent symptomatic, ulcereous plague, heterogeneous and lipid rich plague) and intramural hemorrhage and intraluminal thrombus, as there is no need to pass through the stenosis area, although the placement is more difficult comparing to distal EPD placement (2,4). Although there are evidences that proximal EPD protects the brain against the microembolization more than distal EPD (5), this difference cannot be identified clearly in meta-analyzes (3).…”

Section: Discussionmentioning

confidence: 99%

Transient neurological deficites due to proximal protection in carotid artery stenting

Gökçe¹,

Yıldız²,

Çöklü³

2019

TÃ¼rk Beyin Damar Hast Derg

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The most feared and frequent complication of carotid artery stenting is distal embolization during the intervention.. To prevent to embolization in clinical practise, roughly two categories of embolic protection devices (EPDs) are routinely used: distal EPDs with flow preservation using filters, and the proximal occlusive protective systems. We report a case with transient neurological deficit such as monoparesia and anosognosia following of the internal carotid artery stenting using a proximal EPD (the Mo.Ma system). The proximal occlusive protective system may cause transient signs and symptoms due to cerebral hypoperfusion without distal embolization. ÖZETKarotis arter stentlemenin korkulan ve sık karşılaşılan komplikasyonu işlem esnasında oluşacak distal embolidir. Distal embolizasyonu önlemek için kabaca 2 çeşit emboli koruma cihazı veya sistemi geliştirilmiştir. Bunlardan biri lezyon distaline filtre konulması, diğeri ise lezyonun proksimalinde kan akımının kesilmesi ile yapılan koruma sistemidir. Proksimal koruma sistemi (Mo.Ma sistemi) ile karotis artere stent koyduğumuz bir hastada monoparezi ve anosognozi ile giden geçiçi nörolojik defisit gelişmiştir. Proksimal koruma sistemi ile distal emboli olmaksızın serebral hipoperfüzyona bağlı geçici nörolojik belirtiler ve bulgular gelişebilmektedir. Anahtar Sözcükler: Karotis stentleme, proksimal koruma, geçici nörolojik defisit.

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Section: Discussionmentioning

confidence: 99%

Transient neurological deficites due to proximal protection in carotid artery stenting

Gökçe¹,

Yıldız²,

Çöklü³

2019

TÃ¼rk Beyin Damar Hast Derg

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“…However, we have experienced only two cases, and a larger number of cases must be analyzed to evaluate whether our method is more useful than in previous studies. [10][11][12] As indicated in this study, pigtail catheters may be useful in patients with a sharp angle between the subclavian artery and the common carotid artery, but the following limitation is suggested: in case 2, a sharp-angle-mediated approach reduced guidewire operability, and we had to use a torque device to improve the operability. In this study, the use of a torque device improved the operability.…”

Section: Disclosure Statementmentioning

confidence: 93%

“…[10][11][12] Essentially, pigtail catheters themselves were not designed for usage for peripheral blood vessel, and their flexibility and trackability are less marked than those of standard catheters. On the other hand, advantages and disadvantages are two sides of the same coin.…”

Section: Disclosure Statementmentioning

confidence: 99%

Induction of a Guiding Sheath to Carotid Artery without Intra-aortic Manipulation by Using a Pigtail-type Inner Catheter: Technical Note and Report of Two Cases

Hirota

Yoshimura

Fujii

et al. 2018

JNET

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Objective: Catheter operations in the aortic arch with atheromatous ulcers, aortic aneurysms, or artificial blood vessels increase the risk of complications, such as cholesterin embolism. We report two cases in which a guiding sheath was directly guided into the right carotid artery through the radial artery using a 5 Fr 110-cm pigtail catheter as an inner catheter to avoid the above complications.Case Presentations: Case 1: A 51-year-old female with an anterior communicating artery aneurysm. Balloon-assisted embolization of the aneurysm was performed using this method as she had undergone aortic arch replacement.Case 2: A 74-year-old male with stenosis of the right internal carotid artery. Carotid artery stenting (CAS) was conducted using this method due to shaggy aorta. Conclusion:This method may be simple and useful for avoiding the complexity of catheter exchange and risk of intraaortic-arch manipulation.

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“…A study from Italy reported the outcomes of 214 patients undergoing CAS via a transradial ( n = 154) or a transbrachial ( n = 60) approach with either the Mo.Ma proximal protection ( n = 61) or the distal filter protection ( n = 163)[36]. As a result of technical difficulties in catheterizing the target vessel, crossover to a femoral approach was required in 11 of 153 (7.1%) filter patients, but only in 1 of the 61 (1.6%) Mo.Ma patients.…”

Section: Head-to-head Comparison/combination Of Strategiesmentioning

confidence: 99%

“…After a mean follow-up of 8.1 ± 7.5 mo, chronic radial artery occlusion was detected by Doppler ultrasound in 2 of the 30 (6.6%) Mo.Ma patients and by clinical assessment in 4 of 124 (3.2%) filter patients ( P = 0.25). The conclusion reached was that CAS with proximal protection via a transradial or a transbrachial approach is a safe, feasible and effective technique with low rate of vascular complications[36]. …”

Section: Head-to-head Comparison/combination Of Strategiesmentioning

confidence: 99%

Transcervical access, reversal of flow and mesh-covered stents: New options in the armamentarium of carotid artery stenting

Paraskevas

Veith

2017

WJC

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In the last 25 years, the very existence of carotid artery stenting (CAS) has been threatened on a number of occasions. The initial disappointing results that even lead to the discontinuation of an early randomized controlled trial have improved considerably with time. Novel devices, advanced stent and equipment technology, alternative types of access and several types of filters/emboli protecting devices have been reported to reduce stroke/death rates during/after CAS and improve CAS outcomes. The present review will provide a description of the various technology advances in the field that aim to reduce stroke and death rates associated with CAS. Transcervical access, reversal of flow and mesh-covered stents are currently the most promising tools in the armamentarium of CAS.

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Carotid Artery Stenting With Proximal Embolic Protection via a Transradial or Transbrachial Approach

Abstract: CAS with proximal protection via a TR or TB approach is a feasible, safe, and effective technique with a low rate of vascular complications.

Cited by 40 publications

References 32 publications

Transient neurological deficites due to proximal protection in carotid artery stenting

Transient neurological deficites due to proximal protection in carotid artery stenting

Induction of a Guiding Sheath to Carotid Artery without Intra-aortic Manipulation by Using a Pigtail-type Inner Catheter: Technical Note and Report of Two Cases

Transcervical access, reversal of flow and mesh-covered stents: New options in the armamentarium of carotid artery stenting

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