Endovascular stenting of supra-aortic lesions using a transcarotid retrograde approach and flow reversal: A multicenter case series

Balceniuk, Mark D.; Hosn, Maen Aboul; Corn, Robert; DerDerian, Trevor; Grimsley, Bradley R.; Long, Paul R.; Moore, Wesley S.; Rossi, Peter J.; Shakir, Hakeem J; Siddiqui, Adnan H.; Spadone, Donald P.; Waqas, Muhammad

doi:10.1016/j.jvs.2019.08.269

Cited by 16 publications

(51 citation statements)

References 49 publications

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“…Retrograde stenting with direct puncture of the CCA has been performed in some studies. [3][4][5] Direct puncture of the CCA is a safe treatment because of the catheter stability and low perioperative stroke risk; however, exposure to the CCA is slightly invasive. An antegrade approach with some techniques has been reported, such as the buddy wire technique, using the gooseneck snare, distal balloon anchoring, stenting after the lesion crosses the guiding catheter, sheath pull-through technique, and the pull-through technique with direct puncture of the CCA.…”

Section: Discussionmentioning

confidence: 99%

Stenting of the Common Carotid Artery Ostium: Balloon Catheter Lifting-Up Technique With a Gooseneck Snare

Terakado¹,

Matsumaru

Ishikawa

2023

Vasc Endovascular Surg

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Endovascular revascularization of a stenotic lesion requires appropriate stent positioning. In particular, stenting of the common carotid artery (CCA) ostium makes it difficult to avoid proptosis into the aorta. Furthermore, the guiding catheter may become unstable during the stenting because of its position under the aortic arch. To resolve these problems, we performed antegrade stenting for a patient with a symptomatic stenotic left CCA ostium that was treated by lifting a balloon-guiding catheter with a gooseneck snare. Our patient was a 74-year-old man who presented to the hospital with main complaints of right hemiparesis and motor aphasia. A left cerebral infarction due to severe stenotic left CCA ostium was diagnosed. A CT perfusion study showed decreased cerebral blood flow in the left hemisphere. Stenting of the stenotic left CCA ostium was performed using an antegrade approach. A balloon-guiding catheter positioned under the aortic arch was inflated and lifted from the right brachiocephalic artery using a gooseneck snare. The guiding catheter was stabilized during stenting. This method is highly effective for stenting CCA ostium.

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Section: Discussionmentioning

confidence: 99%

Stenting of the Common Carotid Artery Ostium: Balloon Catheter Lifting-Up Technique With a Gooseneck Snare

Terakado¹,

Matsumaru

Ishikawa

2023

Vasc Endovascular Surg

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“…Review of the literature pertaining to retrograde angioplasty and stenting of supra-aortic stenotic lesions via the carotid artery in the neck for single lesions or in tandem with carotid bifurcation disease revealed a retrospective multi center case series by Balceniuk et al 8 Those authors describe treatment of 16 patients, with single stenotic lesions in 11 patients and in tandem with carotid bifurcation disease in 5 patients using the ENROUTE Neuroprotection flow reversal system from Silk Road. Excellent results with 100% technical success was described in this report.…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde stenting of IA and CCA lesions using the ENROUTE Neuroprotection System has also been described in a retrospective case series from nine centers in the United States. 8 A modification of the technique described is proposed and illustrated with a case example. IRB approval was not required by our institution due to small number of patient cases presented.…”

Section: Introductionmentioning

confidence: 99%

Transcarotid artery revascularization in reverse for innominate artery stenosis

Mukherjee

Kittner

2022

Vascular

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Stenotic lesions of the supra-aortic vessels have been reported in 2–6% of patients presenting with corresponding symptoms. In the past, these lesions have been treated with open surgical techniques. More recently, endovascular treatment approaches have been proposed for occlusive lesions in the innominate (IA) or common carotid (CCA) arteries. Retrograde stenting of IA and CCA lesions using flow reversal has been described in a retrospective case series; however, a modification of their technique is proposed. Case Presentation: The patient is a 68-year-old male with symptoms of right upper extremity claudication. CT angiogram revealed critical stenosis of the innominate artery and high-grade stenosis of the right subclavian artery. The patient consented to retrograde stenting of the innominate stenosis with neuroprotection using flow reversal or transcarotid revascularization (TCAR) in reverse. Surgical cut-down was performed of the carotid bifurcation, and a U-stitch was placed on the anterior wall of the distal common carotid artery. Flow reversal was achieved by connecting the arterial sheath to the venous sheath. The innominate lesion was crossed, primarily stented with a VBX stent, and post-dilated with a non-compliant balloon. Just prior to crossing the lesion and primary stent placement, the vessel loop around the common carotid and internal carotid arteries were pulled up to ensure neuroprotection while the stent was expanded. This was continued for two minutes before restoring antegrade flow first in the external carotid and then in the internal carotid artery. There were no adverse events. At one month follow-up, the patient reported no right arm claudication symptoms. TCAR for the proximal lesion as described in other case series may not adequately attain flow based neuroprotection. Under that circumstance, the arterial sheath is acting as a conduit to deliver the stent. Risk of embolization to the brain may not be mitigated when the proximal lesion is stented and antegrade flow restored.

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“…To ensure the homogeneity of the enrolled patients, treatment modalities such as stenting thrombectomy, arterial thrombolysis, and balloon dilatation were excluded, and intravascular stent implantation was adopted. Patients were lying flat on the operating table, after routine disinfection, draping, and local anesthesia, femoral artery puncture and sheathing were performed, 5F catheter was transmitted under wire guidance to the proximal end of stenosed artery for imaging, after determining the route, diameter, and length of stenosed lesion of the vessel, a suitable stent was selected and relieved precisely under wire guidance, after stent implementation, digital subtraction angiography (DSA) was performed to check the stent relief status and whether the remote vessel was smooth, and when the imaging showed that the stent was well placed, the catheter and wire were withdrawn, the arterial sheath was pulled out, and the puncture point was pressed [ 12 ]. Patients were repeatedly advised to lie on the back for 24 h, and 4 h after surgery, their activated partial thromboplastin time (APTT) was tested, and if it was within 50–70s, extubation could be performed, and then, the patients should lie on the back for another 24 h, with their puncture point being pressed for 6 h. Patients' various vital signs, including blood pressure, heart rate, breathing, and oxygen saturation were detected, and their urine volume was observed.…”

Section: Methodsmentioning

confidence: 99%

Correlation between Selection of Time Window for Acute Cerebral Infarction and Efficacy of Intravascular Stent Implantation

Feng

Gong²

2022

Journal of Healthcare Engineering

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Objective. To explore the correlation between selection of time window for acute cerebral infarction (ACI) and efficacy of intravascular stent implantation. Methods. The clinical data of 84 ACI patients treated in our hospital from March 2019 to March 2020 were selected for the retrospective analysis, all study subjects received intravascular stent implantation, and after discharge, patients were assessed by the Modified Rankin Scale (mRS) and divided into the good prognosis group (n = 46, mRS score ≤2 points) and poor prognosis group (n = 38, mRS score >2 points). The clinical data of patients in the two groups at admission underwent univariate analysis, the indicators presenting P < 0.05 were included in the logistic regression model, and the correlation between patients’ treatment time window and clinical effect was analyzed by multivariate logistic regression analysis and linear fitting analysis. Results. According to the multivariate logistic regression analysis, low-density lipoprotein (LDL), time window, and blood glucose level before treatment were the independent factors affecting patients’ treatment effect and were associated with the efficacy of intravascular stent implantation (r was 0.790, 0.889, and 0.672, respectively). Conclusion. LDL, time window, and blood glucose level before treatment are the important factors affecting the efficacy of intravascular stent implantation for ACI patients, among which the time window is most significantly associated with the clinical effect. Therefore, ACI patients should accept clinical treatment as early as possible.

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Endovascular stenting of supra-aortic lesions using a transcarotid retrograde approach and flow reversal: A multicenter case series

Cited by 16 publications

References 49 publications

Stenting of the Common Carotid Artery Ostium: Balloon Catheter Lifting-Up Technique With a Gooseneck Snare

Stenting of the Common Carotid Artery Ostium: Balloon Catheter Lifting-Up Technique With a Gooseneck Snare

Transcarotid artery revascularization in reverse for innominate artery stenosis

Correlation between Selection of Time Window for Acute Cerebral Infarction and Efficacy of Intravascular Stent Implantation

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