The coronary technique for complex carotid artery stenting in the setting of complex aortic arch anatomy

Area of Science:

• Interventional Cardiology
• Vascular Surgery
• Neurosurgery

Background:

• Carotid artery stenting (CAS) is an alternative for patients at high risk for carotid endarterectomy.
• Complex aortic arch anatomy poses significant challenges for standard CAS procedures.
• Accessing the carotid artery origin can be difficult in patients with aberrant anatomy.

Purpose of the Study:

• To evaluate the safety and efficacy of a modified "coronary technique" for CAS.
• To assess the feasibility of treating carotid artery lesions in patients with complex aortic arch anatomy.
• To describe a novel approach for CAS when standard methods are precluded by anatomical variations.

Main Methods:

• Retrospective review of 8 patients with complex aortic arch anatomy undergoing CAS.
• Utilized femoral artery catheterization and an Amplatz AL1 guide catheter for carotid artery access.
• Employed a "coronary technique" to deliver protection devices and stents.

Main Results:

• Successful CAS was achieved in all 8 patients with complex anatomy.
• No instances of dissection, neurovascular deficit, or other major complications were reported.
• The "coronary technique" facilitated stent delivery in cases where standard access failed.

Conclusions:

• The described "coronary technique" is a safe and viable method for CAS in patients with complex aortic arch anatomy.
• This approach expands treatment options for patients previously considered unsuitable for CAS.
• The AL1 guide catheter facilitates successful carotid artery stenting in challenging anatomical scenarios.