A diffusion-weighted magnetic resonance imaging-based study of transcervical carotid stenting with flow reversal versus transfemoral filter protection

Abstract

These data suggest that transcervical carotid stenting with carotid flow reversal carries a significantly lower incidence of new ischemic brain infarcts than that resulting from transfemoral CAS with a distal filter. The transcervical approach with carotid flow reversal may improve the safety of CAS and has the potential to improve results in especially vulnerable patients such as the elderly and symptomatic.

Techniques for Optimizing Results in Carotid Stenting

“…Although the experience is still small and prospective trials are needed, the short-term and long-term outcomes are also good and appear comparable with the reported results for carotid revascularization by endarterectomy [66,67]. This technique promises to improve the neurologic outcomes of CAS as it has been associated with a lower incidence of new ischemic brain infarcts on diffusion-perfusion magnetic resonance imaging when compared to transfemoral CAS with a distal filter [68].…”

Commentary: Carotid Artery Revascularization for Stroke Prevention

“…Technological advancements, including mesh-covered carotid stents for sustained embolic prevention, 11,13,62,64,65,72 taken together with optimized use of temporary protection (with a focus on proximal protection systems for high-risk lesion subsets in particular 11,53,54,56,57,60,66 ) and increased endovascular operator experience 70 may ultimately make CAS a safer procedure that CEA. 35 …”

“…[57][58][59] According to "tailored CAS" algorithms, 11,53,60 proximal neuroprotection is preferred in endovascular management of symptomatic and high-risk asymptomatic lesions. The use of ultra-closed-cell stent systems (achieved by covering the nitinol frame with a mesh made of different materials), on the other hand, not only further reduces the risk of intraprocedural neurologic complications but also, by preventing plaque protrusion through stent struts, eliminates postprocedural cerebral embolization as manifested on routine diffusion-weighted magnetic resonance imaging (DW-MRI).…”

Transbrachial Angioplasty and Stenting without Crossing the Aortic Arch for Right Carotid Artery Stenosis Patients with Complex Aortic Plaques

“…14) In other studies, comparing transcervical and transfemoral CAS, no contralateral hemispheric infarcts on DWI-MRI were found in the transcervical CAS group, unlike in the transfemoral CAS group. 15,16) However, transcervical CAS may cause major complications because CCA is close to significant anatomical structures. 14) Thus, transcervical CAS is more invasive than transfemoral, transbrachial, or transradial access.…”