How I do it: cervical access for carotid artery stenting

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.