Significance of Combining Distal Filter Protection and a Guiding Catheter With Temporary Balloon Occlusion for Carotid Artery Stenting: Clinical Results and Evaluation of Debris Capture

Background and purpose Placement of a large-bore guiding sheath or catheter into the common carotid artery (CCA) is crucial in transbrachial carotid artery stenting (CAS). Herein, we describe technical tips for the navigation of a 6-French guiding sheath into the CCA using a tri-axial catheter system in transbrachial CAS. Materials and methods A total of 27 patients underwent transbrachial CAS. For the right side, a 6-French straight guiding sheath was navigated directly into the CCA using a tri-axial catheter system, with a 4-French Simmons catheter placed through a 6-French straight guiding catheter. For the left side, a 6-French Simmons guiding sheath was navigated into the CCA using a tri-axial catheter system, with a 4-French Simmons catheter placed through a 6-French Simmons guiding catheter. After the placement of a 6-French guiding sheath into the CCA, CAS was performed under distal filter or balloon protection. Results Fifteen patients had a right carotid stenosis and 12 patients had a left carotid stenosis. The 6-French guiding sheath was safely placed with ease and provided adequate stabilization for CAS. All procedures were successfully performed without any complications. Conclusion The use of a tri-axial catheter system for the navigation of a 6-French guiding sheath into the CCA appears safe and efficient, allowing transbrachial CAS, with 6-French guiding sheath stabilization, to be performed without any complication.

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Technique and clinical evidence of neuroprotection in carotid artery stenting

VASA ◽

10.1024/0301-1526/a000336 ◽

2014 ◽

Vol 43 (2) ◽

pp. 100-112 ◽

Cited By ~ 1

Author(s):

Rainer Knur

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Clinical Evidence ◽

Carotid Artery Disease ◽

Balloon Occlusion ◽

Protection Devices ◽

Artery Disease ◽

Distal Filter ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

Carotid artery stenting has been advocated as an effective alternative to carotid endarterectomy. Periprocedural embolization of debris during endovascular treatment of carotid artery disease may result in neurological deficit. Different strategies are being developed and evaluated for their ability to minimize the clinical embolic risk. Distal filter devices, proximal and distal balloon occlusion systems are increasingly used in carotid artery stenting, because they seem to be safe and effective in preventing distal embolization, according to several uncontrolled studies. However the use of embolic protection devices is a subject of controversy and no data on their benefit are available from randomized controlled multi-center trials. The technique and clinical evidence of cerebral protection systems during carotid angioplasty and stenting for stroke prevention are reviewed.

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TCT-74 Proximal Balloon Occlusion versus Distal Filter Protection in Carotid Artery Stenting: A Meta-Analysis of Clinical Trial Data

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.08.851 ◽

2015 ◽

Vol 66 (15) ◽

pp. B33-B34

Author(s):

Jad Omran ◽

Obai Abdullah ◽

Belal Firwana ◽

Mazen Abu-Fadel ◽

Christopher White ◽

...

Keyword(s):

Clinical Trial ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Clinical Trial Data ◽

Balloon Occlusion ◽

Trial Data ◽

Distal Filter

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Effect of aortic arch type on technical indicators in patients undergoing carotid artery stenting

Journal of International Medical Research ◽

10.1177/0300060518807604 ◽

2018 ◽

Vol 47 (2) ◽

pp. 682-688 ◽

Cited By ~ 5

Author(s):

Songhe Shen ◽

Xiongjing Jiang ◽

Hui Dong ◽

Meng Peng ◽

Zhixue Wang ◽

...

Keyword(s):

Carotid Artery ◽

Contrast Agent ◽

Aortic Arch ◽

Carotid Artery Stenting ◽

Influential Factor ◽

Fluoroscopy Time ◽

Type I ◽

Technical Indicators ◽

Type Iii ◽

Guiding Catheter

Objective This study was performed to explore the effect of the aortic arch type on technical indicators in patients undergoing carotid artery stenting (CAS). Methods The data of 224 consecutive patients who underwent unilateral CAS from January 2011 to December 2012 were retrospectively analyzed. The requirement for placement of the guiding catheter into the common carotid artery with assistance of an angiographic catheter, fluoroscopy time, contrast agent dose, and adverse events were recorded. Results The fluoroscopy time was significantly longer and the contrast agent dose was significantly higher in patients with Type III than Type I and II arches. Significantly more patients with Type III than Type I and II arches required placement of the guiding catheter with assistance of an angiographic catheter (46.2% vs. 15.0%, respectively). The procedural success rate was significantly lower in patients with Type III than Type I and II arches (96.2% vs. 100.0%, respectively). The incidence of death, myocardial infarction, and all types of stroke was significantly higher in patients with Type III than Type I and II arches (7.7% vs. 1.7%, respectively). Conclusions The aortic arch type is an important influential factor in CAS. Type III arches are associated with more difficulties and complications.

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Three-Year Clinical Results of Carotid Artery Stenting in Treating Patients with Contralateral Carotid Artery Occlusion

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2017.12.016 ◽

2018 ◽

Vol 27 (5) ◽

pp. 1296-1301 ◽

Cited By ~ 1

Author(s):

Jianming Guo ◽

Lianrui Guo ◽

Zhu Tong ◽

Zhonggao Wang ◽

Alan Dardik ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Clinical Results ◽

Artery Occlusion ◽

Carotid Artery Occlusion

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Novel triple coaxial system to navigate 9 French balloon guiding catheter into common carotid artery

Interventional Neuroradiology ◽

10.1177/1591019920930169 ◽

2020 ◽

Vol 26 (6) ◽

pp. 719-724

Author(s):

Ryuta Yasuda ◽

Naoki Toma ◽

Yume Suzuki ◽

Yoichi Miura ◽

Masato Shiba ◽

...

Keyword(s):

Carotid Artery ◽

Common Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

External Carotid Artery ◽

External Carotid ◽

Type Iii ◽

Catheter System ◽

Bovine Aortic Arch ◽

Guiding Catheter

Background It is often hard to navigate a 9 French (F) balloon guiding catheter in patients with type III or bovine aortic arch. Also, a common carotid artery stenosis is challenging, because a guidewire cannot be advanced distally. We developed the combination of a 4F Simmons-type catheter and a 6F distal access catheter as a coaxial inner catheter to navigate a 9F balloon guiding catheter to overcome these difficulties. Materials and methods Medical record at our institution was retrospectively reviewed and carotid artery stenting cases in which the 4F Simmons-6F distal access catheter system was employed as a coaxial catheter to navigate a 9F balloon guiding catheter were identified. To construct this system, a 4F 145 cm SY3 (Hanako Medical, Saitama, Japan) and a 6F 118 cm Cerulean DD6 (Medikit Co. Ltd., Tokyo, Japan) were usually employed. A rotating hemostatic valve should be as short as possible and was attached to only a 9F balloon guiding catheter. The length of a 0.035-in. guidewire needed to be 180 cm or longer. Results During the study period, 106 carotid artery stenting cases were identified. Of these, this system was employed in 29 cases that included 5 cases with a steno-occlusive lesion at common carotid artery/external carotid artery, 10 with type III or bovine arch, and 11 harboring both. In all the cases, a 9F balloon guiding catheter was successfully navigated. Conclusion The 4F Simmons-6F distal access catheter system was useful in navigating a 9F balloon guiding catheter in patients with a common carotid artery stenosis, an external carotid artery occlusion, and an in-stent restenosis, especially when they also harbored type III or bovine aortic arch.

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