Proximal Endovascular Flow Blockage for Cerebral Protection During Carotid Artery Stenting:Results From a Prospective Multicenter Registry

Abstract

Cerebral protection with proximal endovascular blood flow blockage during CAS is feasible, with a high procedural success rate.

Predictors of Carotid Occlusion Intolerance During Proximal Protected Carotid Artery Stenting

“…Proximal occlusion devices stop or reverse flow by occluding the carotid artery, much in the same way that a carotid endarterectomy accomplishes neuro-protection. An OP #40 mm Hg after occlusion of the CCA has been suggested to be a predictor of OI(12,13) during proximal protected CAS, and our study provides the definitive proof of this hypothesis.Measuring blood pressure (stump pressure) in the distal ICA during occlusion of the ICA is reported to be a reliable safety index to predict ischemia after permanent occlusion of the ICA (carotid sacrifice) performed for the management of complex cerebral aneurysms(14). Of note, the OP threshold of 40 mm Hg that we found associated with the development of OI corresponds to the literature regarding balloon test occlusion for carotid sacrifice used by cerebral angiographers(14).…”

Neuroprotection during carotid artery stenting using the GORE flow reversal system: 30‐day outcomes in the EMPiRE Clinical Study

“…Reported rates of intolerance in earlier studies of flow reversal range from 0 to 8.9% [23][24][25][26][27][28][29]; the rate in the EMPiRE study was 2.4%. Trials of a flow arrest EPD had intolerance rates of 5.8-13.8% [17][18][19][20][21]. Intolerance during flow reversal may be controlled by blood pressure management or by temporarily deflating the CCA balloon to restore antegrade flow and reinflating the balloon once baseline neurologic status is reestablished.…”

“…The proximally placed flow arrest system avoids the need to cross the lesion to establish protection. Proximal flow arrest, however, like distal vessel occlusion, may not be tolerated in some patients [17][18][19][20][21].…”

Heparin versus bivalirudin for carotid artery stenting using proximal endovascular clamping for neuroprotection: Results from a prospective randomized study

“…1 Once the diagnostic angiogram was completed, the neuroprotection system (Mo.Ma system, Invatec, Roncadelle, Italy) was positioned in the distal external carotid artery (ECA; Fig 1). [14][15][16][17] At this point, the distal balloon was inflated in the ECA and the proximal balloon in the common carotid artery (CCA), thus establishing neuroprotection. A 0.014Љ guidewire was then navigated through the lesion.…”