The modified ‘no touch’ technique in the antegrade endovascular approach for left common carotid artery ostial stenosis stenting

2016 ◽  
Vol 9 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Xiaobin Tang ◽  
Whitney Annie Long ◽  
Chang Hu ◽  
Feng Tang ◽  
Qian Wang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Success Rate ◽  
Common Carotid Artery ◽  
Open Surgery ◽  
Left Common Carotid Artery ◽  
Long Term Results ◽  
Minor Stroke ◽  
Procedure Time ◽  
Endovascular Approach

BackgroundOpen surgery and the retrograde endovascular approach via the distal left common carotid artery (LCCA) have some limitations in LCCA ostial stenosis treatment. The ‘no touch’ technique used in the renal artery was modified for this situation.MethodsFifteen selective LCCA stenosis patients were treated by the modified ‘no touch’ technique in the antegrade endovascular approach from March 2013 to March 2016. Thirteen underwent the transfemoral approach and the other two had the transbrachial approach due to a ‘bovine aortic arch’. Distal embolic protection devices were used in all cases. Follow-up included a neurological examination, carotid duplex scan, and office interview. Mean follow-up time was 18.2±11.5 months.ResultsThe initial technical success rate was 100%. The average procedure time was 84.0±16.3 min. There were no procedure-related deaths. No clinical neurological complications occurred during the in-hospital stay. No incidence of death or major stroke occurred during the follow-up period; 6.7% (1/15) of patients had a contralateral minor stroke, 66.7% (4/6) of symptomatic patients were relieved of initial symptoms, and the rest showed improvement. No patient developed new ipsilateral neurological symptoms and no in-stent restenosis occurred during the follow-up period. These results were confirmed by ultrasound.ConclusionsThe modified ‘no touch’ antegrade endovascular technique is a feasible method for treating LCCA ostial lesions with a satisfactory initial success rate, acceptable procedure time, and comparable mid- and long-term results. This technique could be considered as a complementary option for LCCA ostial stenosis in addition to open surgery and the retrograde endovascular approach.

Combined surgical and endovascular approach to treat symptomatic in-stent occlusion of the left common carotid artery origin

2009 ◽  
Vol 110 (5) ◽  
pp. 935-938
Author(s):  
Qaisar A. Shah ◽  
Muhammad Zeeshan Memon ◽  
Ramachandra P. Tummala ◽  
Adnan I. Qureshi
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Left Common Carotid Artery ◽  
Transfemoral Approach ◽  
Stent Occlusion ◽  
Guide Catheter ◽  
Occlusive Lesion ◽  
Endovascular Approach ◽  
Endovascular Devices ◽  
Gain Access

Symptomatic occlusive lesions at the origins of the supra-aortic vessels pose challenges for treatment. Endovascular angioplasty and stent placement via the transfemoral approach is possible, but obtaining a stable position for the guide catheter via this approach is technically difficult. The authors describe the case of a 56-year-old man presenting with symptomatic occlusion of a previously placed stent at the origin of the left common carotid artery (CCA). An endovascular revascularization of the left CCA was planned. However, the absence of a lumen proximal to the stent prevented stable placement of a guide catheter via the transfemoral route. Consequently, the authors used a combined surgical and endovascular approach to gain access to the lesion. The left CCA was exposed surgically distal to the occlusion and clamped just proximal to its bifurcation to preserve flow from the external to the internal carotid artery (ICA) and to prevent embolism into the ICA. A wire was passed retrograde through the occlusive lesion and then was subsequently advanced proximally into the femoral sheath. This allowed transfemoral advancement of the appropriate endovascular devices to perform an angioplasty and placement of a stent. The patient remained neurologically stable, and postoperative studies showed improvement in cerebral perfusion. This case demonstrates the feasibility of distal-to-proximal stent delivery with a combined endovascular and surgical approach.

scholarly journals Extracranialis carotis aneurysmák korszerű kezelése

2019 ◽  
Vol 160 (21) ◽  
pp. 815-821
Author(s):  
Áron Nyilas ◽  
Zsolt Palásthy ◽  
Zsuzsanna Mihály ◽  
Enikő Veres-Lakos ◽  
Zoltán Szeberin
Keyword(s):  
Carotid Artery ◽  
Vascular Surgery ◽  
Open Surgery ◽  
Carotid Artery Disease ◽  
Artery Aneurysm ◽  
Long Term Results ◽  
Invasive Treatment ◽  
Carotid Artery Aneurysm ◽  
The Mean

Abstract: Introduction: Aneurysm of the extracranial carotid artery is a rare condition and there is a diversity in the etiology. The proper treatment could be a real challenge for the surgeons. Aim: Analysis of perioperative and long term results of invasive treatment for carotid artery aneurysm. Method: A retrospective review was conducted of patients who had open or endovascular surgery due to carotid artery aneurysm through the last 13 years at the Department of Vascular Surgery of the Semmelweis University and at the Department of Surgery of the University of Szeged. Medical history, characteristics of the aneurysms, therapy and the follow-up results were reviewed. Results: Over the study period, 25 interventions were performed due to carotid artery aneurysm. There were 10 men and 15 women with a mean age of 57.8 ± 15.15 years. Seventeen patients (68%) were symptomatic. The mean aneurysm diameter was 26.8 ± 11.25 mm. The underlying etiology was atherosclerosis in eleven (44%), prior carotid endarterectomy in four (16%), infection in four (16%) and other cause (connective tissue disease, dissection, trauma) in six (24%) cases. Nineteen patients underwent open surgery, six underwent endovascular treatment. Death within 30 days was documented in one (4%) case. The mean postoperative hospital stay was 4.52 ± 2.38 days. Three (12%) patients required reintervention postoperatively. Peripheral nerve injuries were detected in four (16%) patients, all after open surgery. No stroke was documented within 30 days. The mean follow-up was 41.2 ± 38.54 months. Five (24%) deaths were not related to the carotid artery disease. One patient had stroke, one had transient ischaemic attack (TIA), and in two cases asymptomatic internal carotid artery occlusion was described. Conclusion: Both open surgery and endovascular intervention can be safely applied in the treatment of carotid artery aneurysm. Considering the variable etiology and rarity, we recommend to perform the interventions in vascular surgery centres. Orv Hetil. 2019; 160(21): 815–821.

An isolated left common carotid artery from the main pulmonary artery in a neonate with aortic valve atresia

2015 ◽  
Vol 25 (6) ◽  
pp. 1193-1196 ◽  
Author(s):  
Alireza Ahmadi ◽  
Mohammadreza Sabri ◽  
Bahar Dehghan
Keyword(s):  
Aortic Valve ◽  
Carotid Artery ◽  
Pulmonary Artery ◽  
Ct Angiography ◽  
Common Carotid Artery ◽  
Main Pulmonary Artery ◽  
Left Common Carotid Artery ◽  
Bilateral Pulmonary Artery Banding ◽  
Patent Ductus

AbstractA 20-day-old girl was referred to our clinic for systolic murmur, cyanosis, and dyspnoea with feeding. Echocardiography revealed an atretic aortic valve. CT angiography scan revealed that the left common carotid artery originated from the distal main pulmonary artery. The plan was patent ductus artriosus stenting and bilateral pulmonary artery banding and then follow-up for any possible future intervention.

scholarly journals Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Alessandro Robaldo ◽  
Guido Carignano ◽  
Alberto Balderi ◽  
Claudio Novali
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
High Risk Patient ◽  
Carotid Bifurcation ◽  
Left Common Carotid Artery ◽  
The Right ◽  
Bovine Aortic Arch ◽  
Common Carotid Arteries

Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters.

Evaluation of Aortic Zone 2 Proximal Landing Accuracy During Thoracic Endovascular Aortic Repair Following Carotid-Subclavian Revascularization

2021 ◽  
Vol 55 (4) ◽  
pp. 355-360
Author(s):  
Sally H. J. Choi ◽  
Gary K. Yang ◽  
Keith Baxter ◽  
Joel Gagnon
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Retrospective Review ◽  
Average Distance ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Technical Accuracy ◽  
Corrective Procedures

Background: Adequate seal for thoracic endovascular aortic repair (TEVAR) commonly requires landing in zone 2, but can prove to be challenging due to the tortuous and angulated anatomy of the region. Objectives: Our objective was to determine the proximal landing accuracy of zone 2-targeted TEVARs following carotid-subclavian revascularization (CSR) and its impact on clinical outcomes. Methods: Retrospective review of patients that underwent CSR for zone 2 endograft delivery at a tertiary institute between January 2008 and March 2018 was conducted. Technical outcomes were assessed by examining the incidence of intraoperative corrective maneuvers, 1a endoleaks and reinterventions. Distance to target and incidence of LSA stump filling were examined as radiographic markers of landing accuracy. Results: Zone 2-targeted TEVAR with CSR was performed in 53 patients for treatment of dissections (49%), aneurysms (30%) or trauma (21%). Nine (17%) cases required intraoperative corrective procedures: 5 (9%) proximal cuffs due to type 1a endoleak and 4 (8%) left common carotid artery (LCCA) stenting due to inadvertent coverage. Cases performed using higher resolution hybrid fluoroscopy machine compared to mobile C-arm were associated with increased proximal cuff use (OR 8.8; 95% CI 1.2-62.4). Average distance between the proximal edge of the covered graft to LCCA was 8 ± 1 mm and larger distances were not associated with higher rates of 1a endoleak. Twenty-eight (53%) cases of antegrade LSA stump filling were noted on follow-up imaging, but were not associated with higher rates of reinterventions (OR 0.8, 95% CI [0.2-4.6]). Three (6%) patients had a stroke within 30 days and 4 (8%) patients expired within 1 month. Intraoperative corrective maneuvers, post-operative 1a endoleak and reinterventions were not associated with higher rates of stroke or mortality. Conclusion: Using current endografts and imaging modalities, zone 2-targeted TEVARs have suboptimal technical accuracy.

scholarly journals Breaking the Rules: Left Common Carotid Artery from the Main Pulmonary Artery in an Infant with a Vascular Ring

CASE ◽  
2021 ◽  
Author(s):  
Stephan Juergensen ◽  
Emilio Quezada ◽  
Norman H. Silverman ◽  
Jeffrey G. Gossett ◽  
Peter Kouretas ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Pulmonary Artery ◽  
Common Carotid Artery ◽  
Vascular Ring ◽  
Main Pulmonary Artery ◽  
Left Common Carotid Artery

Electrophysiological-anatomic correlates of ATP-triggered vagal reflex in the dog. III. Role of cardiac afferents

1996 ◽  
Vol 270 (5) ◽  
pp. H1785-H1790 ◽  
Author(s):  
G. Katchanov ◽  
J. Xu ◽  
C. M. Hurt ◽  
A. Pelleg
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Left Common Carotid Artery ◽  
Descending Aorta ◽  
Chronotropic Action ◽  
Vagal Reflex ◽  
Vagal Afferent ◽  
The Asymmetry ◽  
Cardiac Afferents ◽  
Afferent Terminals

To test the hypothesis that the asymmetry in the afferent traffic of the intra-right atrium (RA) ATP-triggered vagal reflex is due to the stimulation by ATP of extrapulmonary (i.e., cardiac) vagal chemosensitive afferent terminals, ATP, adenosine, and capsaicin were given into the canine RA and the aortic root (AR; n = 12); ATP and adenosine were also administered into the left common carotid artery and the descending aorta (n = 6). The negative chronotropic action [i.e., suppression of sinus node (SN) automaticity] of the test compounds and time to peak effect (tp) were determined. Under baseline conditions, ATP given into the left common carotid artery had a relatively very small effect. ATP given into the descending aorta had no effect. In contrast, intra-RA and intra-AR ATP markedly suppressed SN automaticity, the former less than the latter; the opposite was true for capsaicin. Intra-RA adenosine was much less potent than intra-RA ATP. The tp of intra-RA ATP and intra-RA adenosine were larger than the tp of intra-AR ATP. Pulmonary denervation did not alter the effects of intra-RAATP, intra-ARATP, or intra-AR capsaicin but almost abolished the effect of intra-RA capsaicin. Subsequent bilateral, but not left, cervical vagotomy markedly reduce the effects of ATP and eliminated the difference between the effects of ATP and adenosine. In addition, tp of intra-RA ATP and intra-AR ATP increased substantially and were similar to tp of adenosine. It was concluded that 1) ATP can stimulate vagal afferent terminals not only in the lungs but also in the heart, 2) the latter constitutes the vagal component of the negative chronotropic action of intra-RA or intra-AR ATP on SN automatically, and 3) the asymmetry in the vagal afferent traffic elicited by ATP in the heart (i.e., right vagal dominance) supersedes the symmetrical vagal afferent traffic triggered by intrapulmonary ATP.

scholarly journals Diagnostic dilemmas of multislice CT angiography in the evaluation of the degree of common carotid artery stenosis

2010 ◽  
Vol 138 (7-8) ◽  
pp. 494-497
Author(s):  
Dragoslav Nenezic ◽  
Slobodan Tanaskovic ◽  
Predrag Gajin ◽  
Nenad Ilijevski ◽  
Goran Vucurevic
Keyword(s):  
Carotid Artery ◽  
Ct Angiography ◽  
Common Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Soft Tissues ◽  
Multislice Ct ◽  
Diagnostic Procedures ◽  
Left Common Carotid Artery ◽  
Artery Stenosis ◽  
High Grade

Introduction. Multislice CT angiography (CTA) is a noninvasive and quick technique to image carotid artery stenosis, as well as intracerebral vasculature. Modern multidetector CTA produces images with a high resolution of, not only the contrast-filled lumen, but also of the vessel wall and the surrounding soft tissues. Multiple studies have verified the ability of CTA to provide an accurate representation of the degree of carotid stenosis in comparison to digital subtraction angiography, both for moderate and high-grade stenosis. Because of its fast and accurate vessel imaging, CT angiography is increasingly used in the assessment of carotid artery stenosis. Case Outline. A 37-year-old female patient was admitted at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, for angiography and endovascular procedure of a high-grade stenosis of the left common carotid artery based on Multislice CT findings brought by the patient. She complained of problems which we considered to be the result of cerebral circulation ischemia. After detailed diagnostic procedures, we concluded that no pathological lesions could be verified either on the left common carotid artery or other supraaortic branches. Therefore, the patient was discharged for further neurological examinations. Conclusion. Although Multislice CTA has many advantages over classical angiography, its validity should be taken with reserve, especially in younger patients.

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