scholarly journals A case of tandem stenoses at the proximal common and internal carotid arteries treated with transbrachial stenting: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 225-229
Author(s):  
Hidemichi Ito ◽  
Masashi Uchida ◽  
Taigen Sase ◽  
Yuichiro Kushiro ◽  
Tetsuya Ikeda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection ◽  
Carotid Stenoses ◽  
The Common

The transfemoral approach is a common technique for carotid artery stenting. However, it has the risk of distal embolism when stenting for a stenosis of the proximal common carotid artery because of poor stability of the guiding catheter resulting in difficulty in setting the embolic protection device prior to stenting. We present a novel therapeutic approach and technique for the treatment of tandem carotid stenoses including the proximal common carotid artery. A 63-year-old man presented with double stenoses at the common carotid artery and internal carotid artery. We used a transbrachial sheath guide that had a 6 Fr (2.24 mm, 0.088 inch) internal diameter and was 90 cm long, and was specifically designed for direct cannulation to the common carotid artery, like a modified Simmons catheter. Because the sheath guide positioned in the aortic arch made it possible to introduce safely the embolic protection device distal to the internal carotid artery stenosis without touching the plaque at the stenosis with no use of any coaxial catheters or guidewires, carotid artery stenting for tandem stenoses could be successfully carried out. The postoperative course was uneventful. In carotid artery stenting, especially for stenosis of the proximal common carotid artery, the sheath guide designed for transbrachial carotid cannulation was useful in stenting the tandem carotid stenoses.

scholarly journals Direct Percutaneous Carotid Artery Stenting for a Patient with Absence of the Common Carotid Artery

2012 ◽  
Vol 18 (3) ◽  
pp. 320-325 ◽  
Author(s):  
S. Toyota ◽  
A. Wakayama ◽  
T. Yoshimine
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Postoperative Radiotherapy ◽  
Internal Carotid Artery Stenosis ◽  
Tonsillar Carcinoma ◽  
The Common

A 54-year-old man with symptomatic internal carotid artery stenosis with absence of the common carotid artery (CCA), who had been treated with surgery and postoperative radiotherapy for tonsillar carcinoma, underwent direct percutaneous carotid artery stenting (CAS). To our knowledge, this is the first report of direct percutaneous carotid artery stenting (CAS) for a patient with absent CCA.

scholarly journals Failed carotid artery stenting followed by successful surgical intervention: Case report

2021 ◽  
Vol 29 (2) ◽  
pp. 259-262
Author(s):  
Valentin Govedarski ◽  
Elitsa Dimitrova ◽  
Zornitsa Vassileva ◽  
Svetoslav Dimitrov ◽  
Svetoslav Iovev
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Left Internal Carotid Artery ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Embolic Protection ◽  
Vascular Walls ◽  
Proper Patient Selection ◽  
Carotid Stenoses ◽  
Selection For

A 56-year-old female patient with significant carotid stenoses with circumferential plaques, causing localized vascular narrowing, was inappropriately indicated for carotid artery stenting. After placement of a distal embolic protection device in the left internal carotid artery, a stent was inserted; however, it could not be fully deployed due to the rigid, severely calcified vascular walls. The various endovascular attempts to recapture the protection device were futile and, eventually, led to fracture of the guidewire of the device and it remained entrapped together with the stent. Emergency carotid arteriotomy with extirpation of the stent and embolic protection device via carotid thromboendarterectomy was performed. In conclusion, the proper patient selection for carotid artery stenting is of utmost importance.

scholarly journals Anatomical Risk Factors for Ischemic Lesions Associated with Carotid Artery Stenting

2014 ◽  
Vol 20 (6) ◽  
pp. 746-754 ◽  
Author(s):  
Go Ikeda ◽  
Wataro Tsuruta ◽  
Yasunobu Nakai ◽  
Masanari Shiigai ◽  
Aiki Marushima ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Artery Stenting ◽  
Diffusion Weighted Imaging ◽  
Internal Carotid ◽  
Cervical Segment ◽  
The Common ◽  
Stenotic Lesions

The purpose of this study was to investigate the anatomical risk factors for ischemic lesions detected by diffusion-weighted imaging (DWI) associated with carotid artery stenting (CAS). DWI was performed within four days after CAS in 50 stenotic lesions between January 2008 and September 2013. We retrospectively analyzed the correlation between the anatomical factors and ischemic lesions associated with CAS. Post-procedural DWI revealed new ischemic lesions after 24 (48%) of the 50 CAS procedures. All three patients with common carotid artery tortuosity, defined as the presence of severe angulation (less than 90 degrees) in the common carotid artery, developed new ischemic lesions. However, there were no significant differences between the patients with and without tortuosity, likely due to the small number of cases. Meanwhile, seven of eight patients with internal carotid artery tortuosity, defined as the presence of severe angulation (less than 90 degrees) in the cervical segment of the internal carotid artery, developed new ischemic lesions. A multivariate analysis showed internal carotid artery tortuosity (odds ratio: 11.84, 95% confidence interval: 1.193–117.4, P= 0.035) to be an independent risk factor for the development of ischemic lesions associated with CAS. Anatomical factors, particularly severe angulation of the internal carotid artery, have an impact on the risk of CAS. The indications for CAS should be carefully evaluated in patients with these factors.

Abstract P540: Safety of Carotid Artery Stenting Without Embolic Protection: A Single Centre Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Christine Hawkes ◽  
Aviraj Deshmukh ◽  
Brian van Adel
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Atheromatous Plaque ◽  
Stroke Rate ◽  
Protection Device ◽  
Single Centre ◽  
Stent Occlusion ◽  
Embolic Protection Device ◽  
Embolic Protection

Introduction: One of the most feared complications of carotid revascularization, including carotid artery stenting (CAS), is peri-procedural ischemic stroke. Several studies suggest that the use of a distal embolic protection device (EPD), as well as over-sized pre- and post-stenting balloon angioplasty, may increase the risk of dislodgement of atheromatous plaque in patients undergoing CAS. The CREST trial, that mandated the use of an EPD, had a peri-procedural ischemic stroke rate of 4.1%. We hypothesize that our technique of stenting without the use of an EPD and sub-maximal angioplasty will have a low risk of peri-procedural complications. Methods: A retrospective review was conducted of consecutive cases of ICA stenting without use of an embolic protection device between January 2012 and June 2020 at a Canadian stroke centre. Data was extracted from the patient electronic medical record and Picture Archives and Communications Systems (PACS). Both symptomatic and asymptomatic CAS cases were included. Results: A total of 220 patients were included in the study, with a median age of 70 years (range 39-93 years), and 83 patients (38%) were female. The vast majority of patients were symptomatic (216 patients [98%]). A large portion of patients had a contralateral ICA occlusion or near occlusion (56 patients [25%]). In the majority of cases, a Precise Cordis RX carotid stent (Cordis) was placed. There were four patients with peri-procedural ischemic strokes (1.8%), with two occurring 8-30 days after stenting. There was one case of acute stent occlusion associated with an ischemic stroke. Two patients (less than 1%) had hyperperfusion syndrome after CAS. Median length of stay following the procedure was one day. Conclusions: In this single centre series, the peri-procedural risks of CAS without using an EPD are low. The ischemic stroke rate is less than 2%, lower than what has been reported in large randomized controlled trials using embolic protection.

scholarly journals Retinal artery occlusion during carotid artery stenting with distal embolic protection device

2018 ◽  
Vol 31 (5) ◽  
pp. 504-508 ◽  
Author(s):  
Kotaro Kohara ◽  
Tatsuya Ishikawa ◽  
Tomonori Kobayashi ◽  
Takakazu Kawamata
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
External Carotid Artery ◽  
External Carotid ◽  
Protection Device ◽  
Embolic Protection Device ◽  
Retinal Artery

Retinal artery occlusion associated with carotid artery stenosis is well known. Although it can also occur at the time of carotid artery stenting, retinal artery occlusion via the collateral circulation of the external carotid artery is rare. We encountered two cases of retinal artery occlusion that were thought to be caused by an embolus from the external carotid artery during carotid artery stenting with a distal embolic protection device for the internal carotid artery. A 71-year-old man presented with central retinal artery occlusion after carotid artery stenting using the Carotid Guardwire PS and a 77-year-old man presented with branch retinal artery occlusion after carotid artery stenting using the FilterWire EZ. Because additional new cerebral ischaemic lesions were not detected in either case by postoperative diffusion-weighted magnetic resonance imaging, it was highly likely that the debris that caused retinal artery occlusion passed through not the internal carotid artery but collaterals to retinal arteries from the external carotid artery, which was not protected by a distal embolic protection device. It is suggested that a distal protection device for the internal carotid artery alone cannot prevent retinal artery embolisation during carotid artery stenting and protection of the external carotid artery is important to avoid retinal artery occlusion.

High Spatial Inhomogeneity in the Intima-Media Thickness of the Common Carotid Artery is Associated with a Larger Degree of Stenosis in the Internal Carotid Artery: The PARISK Study

2016 ◽  
Vol 38 (05) ◽  
pp. 523-529 ◽  
Author(s):  
Jeire Steinbuch ◽  
Anouk van Dijk ◽  
Floris Schreuder ◽  
Martine Truijman ◽  
Alexandra de Rotte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Intima Media Thickness ◽  
Media Thickness ◽  
Common Risk Factors ◽  
The Common ◽  
Ica Stenosis

Abstract Purpose Inhomogeneity of arterial wall thickness may be indicative of distal plaques. This study investigates the intra-subject association between relative spatial intima-media thickness (IMT) inhomogeneity of the common carotid artery (CCA) and the degree of stenosis of plaques in the internal carotid artery (ICA). Materials and Methods We included 240 patients with a recent ischemic stroke or transient ischemic attack and mild-to-moderate stenosis in the ipsilateral ICA. IMT inhomogeneity was extracted from B-mode ultrasound recordings. The degree of ICA stenosis was assessed on CT angiography according to the European Carotid Surgery Trial method. Patients were divided into groups with a low (≤ 2 %) and a high (> 2 %) IMT inhomogeneity scaled with respect to the local end-diastolic diameter. Results 182 patients had suitable CT and ultrasound measurements. Relative CCA-IMT inhomogeneity was similar for the symptomatic and asymptomatic side (difference: 0.02 %, p = 0.85). High relative IMT inhomogeneity was associated with a larger IMT (difference: 235 µm, p < 0.001) and larger degree of ICA stenosis (difference: 5 %, p = 0.023) which remained significant (p = 0.016) after adjustment for common risk factors. Conclusion Regardless of common risk factors, high relative CCA-IMT inhomogeneity is associated with a greater degree of ICA stenosis and is therefore indicative of atherosclerotic disease. The predictive value of CCA-IMT inhomogeneity for plaque progression and recurrence of cerebrovascular symptoms will be determined in the follow-up phase of PARISK.

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