Simultaneous treatment of symptomatic cervical and tandem intracranial carotid lesions using transcarotid artery revascularization
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Crista E Horton1,2, Julieth D Barbosa3, Daniel Shlyak1
1Department of Vascular Surgery, Delray Medical Center, Delray Beach, FL.
Insights
Transcarotid artery revascularization provides a safe method for treating severe tandem carotid artery stenoses in high-risk patients. This technique enables single-session multilevel carotid revascularization when traditional transfemoral access is not feasible.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Medicine
Background:
- Recurrent stroke poses a significant health risk, often linked to severe carotid artery stenosis.
- Tandem stenoses in cervical and intracranial internal carotid arteries (ICA) present complex treatment challenges.
- A hostile aortic arch can complicate standard endovascular access for carotid interventions.
Abstract:
A 75-year-old man with recurrent hemispheric stroke was found to have severe tandem cervical and intracranial internal carotid artery (ICA) stenoses and a hostile aortic arch. Transcarotid artery revascularization with flow reversal enabled safe carotid access for angioplasty and stenting of the cervical and intracranial ICA through the same access. Imaging confirmed excellent luminal restoration without complications, and follow-up ultrasound study showed <50% residual stenosis of the cervical ICA along with no new neurologic symptoms. This case demonstrates that transcarotid artery revascularization can facilitate single-session multilevel carotid revascularization in high-risk patients, offering a safe strategy when transfemoral access is unfavorable.
