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Published on: December 23, 2014
Reverse flow-enhanced catheterization of true lumen in carotid artery dissection: the REFLECT technique
Francesco Mistretta1, Riccardo Russo2, Stefano Molinaro3
1Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Turin, Italy. francescomistretta93@gmail.com.
Insights
We present a novel technique for treating large vessel occlusion caused by carotid artery dissection. This method uses reverse flow to improve true lumen access, enabling successful mechanical thrombectomy and stenting for middle cerebral artery occlusion.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Carotid artery dissection (CAD) leading to large vessel occlusion (LVO) presents significant endovascular treatment challenges.
- Navigating the true lumen in CAD is difficult, risking false lumen entry, distal embolization, and compromised access to the occlusion.
Purpose of the Study:
- To describe a novel technique for endovascularly treating LVO secondary to CAD.
- To demonstrate the successful application of this technique in a case of middle cerebral artery (MCA) occlusion.
Main Methods:
- A case of CAD with MCA occlusion was treated using mechanical thrombectomy with a balloon guide catheter.
- The REFLECT technique (Reverse Flow-Enhanced Catheterization of True Lumen in Carotid Artery Dissection) was employed, utilizing proximal flow arrest to induce flow reversal.
- This facilitated false lumen collapse, improved true lumen visualization and access, followed by revascularization and stenting.
Main Results:
- Successful mechanical thrombectomy and revascularization of the MCA occlusion.
- The REFLECT technique enabled safe and effective navigation to the true lumen.
- Deployment of carotid stents within the true lumen achieved arterial reconstruction and maintained patency.
Conclusions:
- The REFLECT technique offers a viable approach for endovascular treatment of LVO in CAD.
- This method enhances true lumen access and facilitates successful thrombectomy and stenting.
- Reverse flow-induced true lumen navigation is a promising strategy for complex carotid artery dissection interventions.
Abstract:
Endovascular treatment of large vessel occlusion (LVO) caused by carotid artery dissection (CAD) is challenging due to difficulties in identifying and navigating the true lumen. Entering through the false lumen can complicate the procedure, increasing the risk of distal embolization into patent arteries and hindering access to the LVO. We report a case of CAD causing middle cerebral artery (MCA) occlusion, successfully managed with mechanical thrombectomy using a balloon guide catheter. Proximal flow arrest in the dissected carotid artery enabled flow reversal, promoting collapse of the false lumen and improving visualization and access to the true lumen-an approach we term REFLECT technique (Reverse Flow-Enhanced Catheterization of True Lumen in Carotid Artery Dissection). Once the guiding catheter was advanced into the distal healthy carotid segment, intracranial circulation was revascularized. Carotid stents were then deployed within the true lumen to reconstruct the dissected artery and maintain long-term patency.
