Transcervical Carotid Stent Placement in the Setting of a Hostile Neck and a Type III Aortic Arch

2017 ◽  
Vol 51 (5) ◽  
pp. 346-349 ◽  
Author(s):  
Lauren A. Huntress ◽  
Naiem Nassiri ◽  
Randy Shafritz ◽  
Saum A. Rahimi
Keyword(s):  
Carotid Artery ◽  
Neck Dissection ◽  
Aortic Arch ◽  
Radical Neck Dissection ◽  
Hybrid Approach ◽  
Internal Carotid Artery Stenosis ◽  
Left Internal Carotid Artery ◽  
Symptomatic Carotid ◽  
Type Iii ◽  
Hostile Neck

Previous radical neck dissection and neck irradiation pose considerable operative risks in patients requiring carotid endarterectomy for symptomatic carotid disease. Carotid stenting is an acceptable alternative for these patients but carries a higher risk of cerebrovascular accidents especially in patients with type III aortic arch anatomy. Herein, we present a technically challenging case of a patient with an irradiated neck and a history of radical neck dissection who presented with a symptomatic high-grade left internal carotid artery stenosis in the setting of a type III aortic arch. He was treated via a hybrid approach for carotid artery stenting.

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

2018 ◽  
Vol 47 (2) ◽  
pp. 682-688 ◽  
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.

scholarly journals Anatomical Predictors of Left Internal Carotid Artery Catheterization in Transradial Angiography

2021 ◽  
Author(s):  
Seon Woong Choi ◽  
Hoon Kim ◽  
Seong Rim Kim ◽  
Ik Seong Park ◽  
Sunghan Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Internal Carotid ◽  
Multivariable Analysis ◽  
Innominate Artery ◽  
Left Internal Carotid Artery ◽  
Arch Height ◽  
Contrast Enhanced

ABSTRACTIntroductionTransradial angiography (TRA) has received considerable attention in the field of neurointervention owing to its advantages over transfemoral approaches. However, the difficulty of left internal carotid artery (ICA) catheterization under certain anatomical conditions of the aortic arch and its branches is a limitation of TRA. This study aimed to investigate the anatomical predictors of successful catheterization of the left ICA in TRA.Materials and MethodsFrom January 2020 to October 2020, 640 patients underwent TRA at a single institute. Among them, 263 consecutive patients who were evaluated by contrast-enhanced MRI before TRA were included in our study and assigned to success and failure groups, according to whether left ICA catheterization was possible or not. Anatomical predictors that may affect the success of left ICA catheterization in TRA were investigated for the purposes of our study.ResultsThe multivariable analysis included variables that demonstrated significant univariate associations with ICA catherization (P<0.0001). Variables included in the model were the type of aortic arch, height of right subclavian artery, turn-off angle of the left common carotid artery (CCA), distance between innominate artery to the left CCA, angulation of right subclavian artery, and angulation of the left CCA, which we identified as significant predictors of left ICA catheterization.ConclusionSuccess of left ICA catheterization in TRA was related to the vascular geometry of the aortic arch and its branches. Evaluating the anatomical predictors identified in this study using pre-procedure imaging may enhance the success rate of left ICA catheterization in TRA.

scholarly journals Periprocedural Thromboembolic Events Associated with Angioplasty and Stenting of the Extra- and Intracranial Carotid Artery Assessed by Neurological Status and Diffusion-Weighted Magnetic Resonance Imaging (DWI)

2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
Frank Ahlhelm ◽  
Johanna Lieb ◽  
Stefan Ulmer ◽  
Dirk Ahlhelm ◽  
Wolfgang Reith
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Vessel Diameter ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Thromboembolic Events ◽  
Intracranial Stenting ◽  
Symptomatic Carotid ◽  
Diffusion Weighted ◽  
Angioplasty And Stenting

Objective. The purpose of this study was to determine the frequency of thromboembolic events associated with angioplasty and stenting of the carotid artery with special regard to extra- or intracranial localization of stenosis. Methods. Twenty patients with symptomatic intracranial or extracranial internal carotid artery stenosis were treated with stenting and/or angioplasty. In 4 patients stenting was technically not feasible (all in the group with intracranial stenosis). All patients underwent diffusion-weighted imaging (DWI) and neurological examination within 48 hours before and after the procedure to detect periprocedural thrombembolic events. Results. Extracranial carotid angioplasty and stenting (eCAS) was technically feasible and successfull without procedure-related neurological complications in all cases. Intracranial stenting (iCAS) was not feasible in four cases including one patient with a fateful course. Concerning the restoration of the vessel diameter intracranial stenting was not as successful as eCAS, but more effective than balloon angioplasty alone. Incidence of thrombembolic events assessed by DWI was low. The detected periprocedural thrombembolic events were small and clinically silent. Conclusion. The risk of thromboembolic events during the endovascular treatment of symptomatic carotid artery stenosis was rather low for intra- and extracranial stenosis of the ICA in our patient sample, but one fatal course was observed.

Transradial Access or Simmons Shaped 8F Guide Enables Delivery of Flow Diverters in Patients With Large Intracranial Aneurysms and Type III Aortic Arch: Technical Case Report

2012 ◽  
Vol 73 (suppl_1) ◽  
pp. onsE111-onse116 ◽  
Author(s):  
Carolin Dietrich ◽  
Gesa H. Hauck ◽  
Luca Valvassori ◽  
Erik F. Hauck
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Acute Onset ◽  
Third Nerve Palsy ◽  
Type Iii ◽  
Complex Aneurysms ◽  
Transradial Access ◽  
Internal Carotid Artery Aneurysm

Abstract BACKGROUND AND IMPORTANCE: Flow diversion with the pipeline embolization device (PED) is an emerging endovascular technology allowing curative embolization of very large and giant intracranial aneurysms. Many patients with these complex aneurysms are older. The presence of a tortuous type III aortic arch reduces the chances of successful PED delivery and increases the risk of complications. We report 2 technical nuances regarding the delivery of the PED in older patients with a complex aortic arch. CLINICAL PRESENTATION: In case 1, an 87-year-old woman presented with acute-onset left third nerve palsy. Workup demonstrated an 18-mm left posterior carotid wall aneurysm with a large daughter aneurysm on its dome. Endovascular access was complicated by a type III aortic arch with a hyperacute angle at the origin of the left common carotid artery. An 8F Simmons II shaped guide formed a stable platform, allowing successful PED delivery. In case 2, a 76-year-old woman experienced a transient ischemic attack. She harbored a right-sided 20-mm cavernous internal carotid artery aneurysm. She was treated with 2 PEDs deployed via a transradial approach. CONCLUSION: Transradial access or guide support with the 8F Simmons II catheter grants stable access for curative embolization with the PED in elderly patients with a large intracranial aneurysm and a complex aortic arch.

Reconstruction of Carotid Artery in Radical Neck Dissection

1985 ◽  
Vol 12 ◽  
pp. S103-S106 ◽  
Author(s):  
Hiroshi Okamura ◽  
Koshiro Nakamura ◽  
Naoaki Yanagihara
Keyword(s):  
Carotid Artery ◽  
Neck Dissection ◽  
Radical Neck Dissection
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