Transcarotid arterial revascularization for symptomatic carotid web

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Neuroradiology

Background:

• Symptomatic carotid web is a recognized cause of acute ischemic stroke.
• Carotid webs carry a high risk of recurrent ischemic events, even with medical management.
• Surgical options like transfemoral carotid artery stenting and carotid endarterectomy exist, but transcarotid arterial revascularization (TCAR) has not been evaluated.

Purpose of the Study:

• To evaluate the safety and efficacy of TCAR in treating patients with cerebral ischemia caused by carotid webs.
• To assess periprocedural complications and clinical outcomes in patients undergoing TCAR for carotid webs.

Main Methods:

• A series of patients with cerebral ischemia due to carotid web underwent TCAR utilizing flow reversal.
• Patients were monitored for complications during the procedure.
• Follow-up assessments were conducted to evaluate for recurrent ischemic events.

Main Results:

• Six patients (2 male, 4 female, median age 59.5) were treated over 21 months.
• All TCAR procedures were technically successful.
• No periprocedural complications or post-procedural cerebral ischemia were observed during a median follow-up of 21 months.

Conclusions:

• TCAR is a safe and effective treatment option for carotid webs causing cerebral ischemia.
• This small series suggests TCAR can prevent recurrent ischemic events in this patient population.