Aortic arch catheterization during transfemoral carotid artery stenting: an underestimated source of cerebral emboli

Area of Science:

• Neurology
• Vascular Surgery
• Medical Imaging

Background:

• Cerebral embolization is a significant risk for patients undergoing transfemoral carotid artery stenting (CAS).
• Current monitoring techniques like transcranial Doppler (TCD) and diffusion-weighted magnetic resonance imaging (DW-MRI) highlight the impact of aortic arch catheterization on embolic load.
• Transcervical access (surgical or percutaneous) has been proposed as an alternative to reduce cerebral embolization during CAS.

Purpose of the Study:

• To review existing transcranial Doppler (TCD) and diffusion-weighted magnetic resonance imaging (DW-MRI) data.
• To evaluate the evidence supporting transcervical carotid artery stenting (CAS) as a method to reduce cerebral embolization.
• To present the clinical outcomes associated with transcervical CAS.

Main Methods:

• Literature review of studies utilizing TCD and DW-MRI for embolic load assessment during CAS.
• Analysis of data comparing transfemoral CAS with transcervical CAS approaches.
• Compilation and review of clinical results from transcervical CAS procedures.

Main Results:

• TCD and DW-MRI data suggest that aortic arch catheterization contributes to the embolic burden during transfemoral CAS.
• Evidence indicates that transcervical access may mitigate the risk of cerebral embolization compared to the transfemoral approach.
• Clinical results for transcervical CAS are presented, offering insights into its efficacy and safety.

Conclusions:

• Transcervical access for carotid artery stenting (CAS) shows promise in reducing cerebral embolization.
• TCD and DW-MRI data provide a basis for considering transcervical CAS as a safer alternative.
• Further investigation into the clinical outcomes of transcervical CAS is warranted.