Technical report: Combined carotid bifurcation endarterectomy and intra-operative transluminal angioplasty of a proximal common carotid artery stenosis: an alternative to extrathoracic bypass

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.…”

“…Another special advantage of this method is protection against embolism, a significant complication of carotid angioplasty and stenting, by clamping of the internal carotid artery during the procedure. 16) The present case of isolated stenosis of the proximal portion of the left common carotid artery was treated by retrograde balloon angioplasty and stenting via the exposed common carotid artery with cerebral protection ensured by internal carotid artery clamping. We believe this technique to be a safe and effective alternative to conventional surgery, especially if use of the transfemoral approach is difficult.…”

“…6) Selective common carotid artery angiography and carotid ultrasonography may miss more proximal lesions, especially if full examination of the origin of the common carotid artery is not performed. 16) Aortography is more useful for detection of stenosis of the proximal common carotid artery. 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.…”

“…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.…”

Cerebral Protection During Retrograde Carotid Artery Stenting for Proximal Carotid Artery Stenosis-Technical Note-

“…Combined carotid endarterectomy and retrograde angioplasty or carotid artery stenting to treat mixed carotid bifurcation and proximal CCA stenosis has been reported, 1,3,6) but carotid artery stenting for isolated proximal CCA stenosis has not been well described. 4,7) We previously reported a case treated by the retrograde direct carotid approach.…”