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Endovascular Stenting of Tandem Carotid Artery Origin and Bifurcation Stenotic Lesions Using Flow Reversal
Andrew A Fanous1,2, Parham Yashar3, Ashish Sonig1,2
1Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Insights
A novel endovascular technique for treating tandem internal carotid artery and common carotid artery stenosis offers a safer alternative. This approach reduces peri-operative risks by avoiding aortic arch navigation and enabling distal embolic protection.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Medicine
Background:
- Tandem lesions of the internal carotid artery (ICA) and common carotid artery (CCA) origin present complex treatment challenges.
- Existing treatments like endarterectomy and stenting carry high risks or are anatomically limited.
- Optimal management for these stenotic lesions remains an unmet clinical need.
Purpose of the Study:
- To introduce a novel endovascular technique for treating tandem ICA and CCA origin stenoses.
- To present a potentially safer and more feasible alternative to current treatment modalities.
Main Methods:
- A direct carotid cut-down approach was utilized for vascular access.
- Serial endovascular stenting was performed, combining retrograde and anterograde techniques.
- This method was applied to treat tandem stenotic lesions in the carotid arteries.
Main Results:
- The technique was successfully applied for the first time in North America.
- It bypasses the need for complex aortic arch navigation.
- Facilitates the use of distal embolic protection devices.
Conclusions:
- This novel technique offers a viable alternative for complex tandem carotid artery stenosis.
- It potentially reduces peri-operative ischemic complications.
- Provides a solution for patients with challenging aortic arch anatomy.
Background:
The treatment of tandem lesions involving severe stenosis of the internal carotid artery with concomitant stenosis of the ipsilateral common carotid artery (CCA) origin represents an ongoing challenge. Current options for the treatment of tandem carotid artery origin and bifurcation stenotic lesions include open surgical endarterectomy, endovascular stenting, balloon angioplasty, and hybrid procedures combining both modalities. However, these options are either associated with high peri-operative risks or not always anatomically feasible.
Case Description:
We report, for the first time in North America (to the best of our knowledge), an alternative treatment modality that involves obtaining access through a direct carotid cut-down, with serial treatment of the tandem lesions through a combination of retrograde and anterograde endovascular stenting.
Conclusion:
This technique obviates the need for navigating the aortic arch in patients with difficult arch anatomy and permits the use of distal embolic protection devices, thus decreasing the risk of peri-operative ischemic events.