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Transcervical carotid artery angioplasty and stenting with carotid flow reversal: surgical technique
Enrique Criado1, Manuel Doblas, Juan Fontcuberta
1Division of Vascular Surgery, Stony Brook University Hospital, NY 11794-8191, USA. ecriado@notes.cc.sunysb.edu
Insights
Transcervical carotid artery stenting is a safe and effective technique for treating carotid artery stenosis. This method provides reliable cerebral protection by reversing blood flow, avoiding complications associated with other approaches.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cerebrovascular Disease
Background:
- Carotid artery stenosis poses a significant risk of stroke.
- Existing treatment methods have potential limitations and complications.
- Cerebral protection during intervention is crucial.
Purpose of the Study:
- To evaluate the feasibility and safety of transcervical carotid artery balloon dilatation and stenting.
- To assess the efficacy of flow reversal for cerebral protection.
- To compare the transcervical approach with the transfemoral approach.
Main Methods:
- Performed transcervical carotid artery balloon dilatation and stenting in 40 patients.
- Utilized flow reversal in internal and external carotid arteries for cerebral protection.
- Conducted the procedure under local anesthesia.
Main Results:
- No deaths or strokes occurred in the study cohort.
- One patient experienced a transient ischemic attack due to inadequate flow reversal.
- The technique demonstrated feasibility and safety in treating carotid artery stenosis.
Conclusions:
- Transcervical carotid artery stenting is a feasible and safe option for carotid artery stenosis.
- The technique provides reliable cerebral protection via flow reversal.
- This approach offers advantages over transfemoral methods, including avoiding potential complications and costs.
Abstract:
We have performed this technique in 40 patients with carotid artery stenosis. No deaths or strokes have occured. During the initial experience, one patient in whom flow reversal was not properly established sutained an hemispheric transient ischemic attack. Transcervical carotid artery balloon dilatation and stenting is feasible and safe. It establishes reliable cerebral protection before the carotid lesion is instrumented by reversing flow in the internal and external carotid arteries. It can be done under local anesthesia, and it avoids the potential limitations, complications, and additional cost of the transfemoral approach with protection devices.