Retrograde balloon angioplasty of brachiocephalic or common carotid artery stenoses at the time of carotid endarterectomy

Abstract

Retrograde intraoperative angioplasty of the proximal component of a tandem extracranial lesion has in this series proven to be a safe and durable therapeutic option. This technique has an acceptable restenosis rate in a subset of patients who have been demonstrated to have a shortened life expectancy and a high mortality rate in the follow-up period.

Retrograde Carotid Stenting for Isolated Stenosis of the Proximal Common Carotid Artery-Case Report-

“…The combined use of carotid endarterectomy and retrograde angioplasty with or without stenting is effective and safe performed via an arteriotomy. 12,[14][15][16] In the present case, retrograde carotid stenting by percutaneous direct carotid puncture was considered possible. Carotid stenting requires strong anticoagulation and antiplatelet therapy.…”

“…The natural history of this condition remains unclear, but may cause ischemic stroke, with artery-to-artery embolism or hemodynamic compromise, as may carotid bifurcation stenosis. 12) Therefore, preventive therapy is recommended. Intrathoracic to cervical bypass operation or endarterectomy were indicated for proximal lesions of the supra-aortic branches including the common carotid artery and the brachiocephalic trunk.…”

“…11) More recently, advances in endovascular technology including percutaneous carotid balloon angioplasty and stenting have resulted in improvement of treatment and safe access for extracranial carotid artery stenosis, and even for proximal common carotid artery stenosis. 7,10,[12][13][14][15][16]19) We describe a case of isolated stenosis of the proximal portion of the left common carotid artery treated by retrograde balloon angioplasty and additional stent placement via the exposed common carotid artery with cerebral protection ensured by internal carotid artery clamping.…”

Stenting of the Stenotic Common Carotid Artery Ostium by the Buddy Wire Technique: A Case Report

“…[2][3][4][5][6][7][8][9][10][11][12] While reports restricting the target to the common carotid artery lesions are few, Linni et al 9) observed the absence of cranial nerve damage and lymphorrhea as advantages of endovascular treatment in a study restricted to 52 patients with common carotid artery lesions and recommended endovascular treatment as the first choice and other direct surgical procedures as useful alternatives. Van de Weijer et al 18) reported that lesion cross was impossible in 4 of the 144 patients who underwent endovascular treatment, particularly, in 2 of the 5 patients with occluded lesions.…”

“…To the present, various techniques including bypass, transposition, ring-stripping retrograde CEA, retrograde percutaneous transluminal angioplasty (PTA), CAS, and transfemoral PTA or CAS have been reported, but all these procedures are more complex than CEA or CAS for stenosis of the internal carotid artery origin. [2][3][4][5][6][7][8][9][10][11][12] In performing transfemoral CAS, securing of the stability of the guiding catheter poses a greater problem because of the more proximal location of the lesion, and various techniques for catheter stabilization have been developed. [10][11][12] We performed CAS with the buddy wire technique 13) and a distal filter protection device for a stenotic lesion at the origin of the common carotid artery and obtained a favorable outcome.…”