A meta-analysis of combined endarterectomy and proximal balloon angioplasty for tandem disease of the arch vessels and carotid bifurcation

Abstract

This meta-analysis reports the largest collection of patients having undergone hybrid treatment of tandem disease of the arch vessels and carotid bifurcation. Results from this study show that the combined stroke and death rate with this approach is equal to or better than that for isolated endarterectomy. When possible, balloon angioplasty with stenting of the proximal component of this disease should be pursued to avoid restenosis.

Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch

“…The optimal treatment choice remains complex and debatable, in particular when these lesions are associated with the most common anatomical variant of the aortic arch branching, the so-called “bovine arch.” The more usual subtype is described as the common origin of the brachiocephalic and left common carotid arteries and can occur in as many as 20% of patients [5, 6]. Although standard open surgical repair via transthoracic approach initially showed good early and long-term results [3], at present, due to the high rate of complications and mortality, this treatment has generally reserved for extensive multivessel involvement or after failed endovascular procedures in low-risk patients. T-PTA and stent-supported t-PTA in symptomatic atherosclerotic disease of the supra-aortic vessels have evolved as less-invasive safe access and treatment for MSSVs since the 1990s [7].…”

“…However, due to the high mortality and complication rates, less-invasive extrathoracic approaches, including transfemoral percutaneous transluminal angioplasty (t-PTA) and stent-supported t-PTA, are described to obtain safe access and treatment for MSSV. In case that these approach results are technically difficult, alternative vascular accesses, as retrograde direct carotid approach, are to be considered [3]. We describe a successful hybrid treatment for a proximal critical lesion of the innominate and left common carotid artery in a high-risk patient with a tandem symptomatic right internal carotid stenosis and a concentric vulnerable plaque in the bicarotid common trunk.…”

Endovascular Treatment of Proximal Aortic Arch Lesions through a Retrograde Approach

“…In a meta-analysis published by Sfyroeras et al [2], the 30-day periprocedural mortality and stroke rate were 0.7 and 1.5%, respectively.…”

“…In the meta-analysis performed by Sfyroeras et al [2], only 2 of 133 patients in whom a stroke occurred during the procedure underwent angioplasty [2,12]. All the stents used in our series are balloon-expandable stents.…”

“…Akers et al [1] described a 4.8% prevalence of these lesions in patients who underwent an aortic arch angiogram for suspected carotid artery disease. However, approximately 80% of these lesions are symptomatic [2]. Surgical and endovascular treatment of these tandem lesions is challenging.…”