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How I do it: cervical access for carotid artery stenting
Robert W Feldtman1, Clifford J Buckley, W Todd Bohannon
1Division of Vascular Surgery, Scott and White Clinic, 2401 S. 31st St., Temple, TX 76508, USA. rfeldtman@swmail.sw.org <rfeldtman@swmail.sw.org>
Insights
Atypical aortic arch anatomy poses embolization risks during carotid stenting. Cervical access to the carotid artery offers a safer approach, combining endovascular and open surgical techniques for improved patient outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Cerebrovascular Disease
Background:
- Carotid artery angioplasty and stenting carry risks of embolization, particularly with complex aortic arch anatomy, tortuous vessels, and severe atherosclerotic disease.
- These anatomical challenges complicate endovascular procedures, increasing the likelihood of stroke or transient ischemic attack.
Purpose of the Study:
- To present a safer technique for carotid artery stenting in patients with challenging anatomy.
- To demonstrate the utility of cervical access to the proximal common carotid artery.
- To highlight the benefits of combining endovascular and open surgical approaches.
Main Methods:
- Description of the cervical access technique for proximal common carotid artery exposure.
- Integration of endovascular stenting with open surgical principles.
- Case series illustrating the application of the combined technique.
Main Results:
- The cervical access technique effectively mitigated embolization risks in complex cases.
- Combining endovascular and open surgical methods simplified the procedure and enhanced safety.
- Successful stenting was achieved with reduced complication rates.
Conclusions:
- Cervical access to the carotid artery is a valuable strategy for managing complex carotid artery stenting.
- Hybrid endovascular and open surgical techniques improve safety and efficacy in treating carotid occlusive disease.
- This approach offers a safer alternative for patients with high-risk anatomy.
Abstract:
Atypical aortic arch anatomy, vessel tortuosity, and extensive atherosclerotic disease in the aortic arch and great vessels represent significant risks for embolization during angioplasty and stenting of carotid occlusive lesions. The technique of cervical access to the proximal common carotid artery is demonstrated as a safer means for dealing with these problems. Combining endovascular and open surgical techniques can simplify and help ensure the safety of carotid stent procedures.