Transcervical Carotid Artery Stenting Without Flow Reversal: A Report of Two Cases

Abstract

Case seriesPatients: Male, 78 • Male, 69Final Diagnosis: Severe carotid artery stenosisSymptoms: AsymptomaticMedication: —Clinical Procedure: Carotid artery stentingSpecialty: CardiologyObjective:Unusual or unexpected effect of treatmentBackground:The use of a carotid artery stent (CAS) is a management option for high-risk patients with carotid artery stenosis. An access site for CAS that involves the transcervical approach may be performed percutaneously or may require a cutdown, and usually includes a flow-reversal system to reduce the risk of embolization. Two cases are presented where the transcervical approach to CAS incorporated a distal filter for embolic protection, with a successful outcome.Case Report:1. A 78-year-old man with a history of prior irradiation for head and neck cancer presented for CAS after clinical evaluation showed that he was a poor candidate for carotid endarterectomy (CEA). A femoral approach for carotid artery access was not successful due to a tortuous type III aortic arch. A surgical cutdown of the carotid artery was performed with the use of a distal filter, and the CAS was inserted with no embolic events. 2. A 69-year-old man with an anatomically high bifurcation of his carotid artery was not a candidate for CEA due to limited carotid artery access. Diagnostic carotid angiography was also difficult to perform. The CAS was successfully sited with the use of a distal filter and with no post-procedural complications.Conclusions:CAS is an option for carotid artery stenosis in patients with high surgical risk for CEA. Although a flow-reversal system is usually used to reduce embolic events, these two cases demonstrate that one can also avoid embolism with a distal filter instead.

Transcervical approach for carotid artery stenting with transitory reversal flow: Case report

“…Angiography of the supra-aortic trunks and both extra and intracranial carotid and vertebral arteries was performed to determine the choice of catheters. Imaging evidence of significant carotid artery calcification or atherosclerotic disease increase risk of athero-embolization during the procedure [12] , [13] . It is also more difficult to maneuver wires and catheters into an anatomically challenging arch, such as a type III arch, or when there is severe aortic tortuosity.…”

Transcervical approach for carotid artery stenting without flow reversal: A case report

“…Symptomatic carotid artery stenosis in high-risk patients is often treated by carotid artery stenting (CAS), which is a less invasive method than carotid endarterectomy (CEA), but stenting is associated with considerable periprocedural risk [1] , [2] , [3] . Femoral artery access is commonly used during CAS procedures, but the femoral approach is associated with increased risks of cerebral embolization and arterial dissection in cases with tortuous aortic arches in the common carotid artery (CCA) anatomy [4 , 5] . A transcervical approach may represent an effective alternative in high-risk patients.…”