Endovascular Treatment of Proximal Aortic Arch Lesions through a Retrograde Approach

Abstract

Tandem atherosclerotic lesions of the carotid bifurcation and the ipsilateral proximal common carotid artery (CCA) or innominate arteries (IA) can be challenging to treat. A surgical approach may treat the lesion at the carotid bifurcation, but proximal CCA or IA lesions require a major surgical exposure. An endovascular approach is challenging as well since anatomic variations, such as a type III aortic arch, can render navigation very difficult. We report our experience in the hybrid surgical and endovascular treatment of complex proximal CCA and IA lesions. Eleven patients who underwent hybrid procedures with surgical exposure (with or without endarterectomy) of the carotid artery and retrograde endovascular intervention of a proximal lesion were included in the study. The mean percentage of stenosis was 81%. Seven patients underwent a carotid endarterectomy (CEA), and 4 patients underwent only a surgical cutdown for retrograde endovascular access of the IA or left CCA. All procedures were technically successful. Eight patients had no symptoms within 30 days of the procedure. The hybrid retrograde endovascular approach through carotid exposure with or without CEA appears to be effective and safe in selected patients who have a high-risk complex anatomy of tandem lesions. i 2014 S. Karger AG, Basel

A Systematic Review of Procedural Outcomes in Patients With Proximal Common Carotid or Innominate Artery Disease With or Without Tandem Ipsilateral Internal Carotid Artery Disease

“…In nine series, outcomes for more than one treatment strategy were published. 45,46,49,51,53,55,61,64,72 Two studies may have had minor overlap regarding case inclusion. 7,82 This was clarified with the senior author (Dr Clouse, personal communication) and neither study was excluded to ensure that all subjects were included.…”

Rendezvous endovascular common carotid artery stenting (RECCAS) technique for symptomatic steno-occlusive disease

“…A retrograde CCA approach allows for easier passage across the site of stenosis into the aortic arch compared with antegrade techniques, most commonly via the common femoral artery. (Makaloski et al, 2017 ; Paukovits et al, 2008 ) The retrograde CCA technique requires extensive dilatation of the common carotid artery which typically warrants an open surgical exposure(Samaniego et al, 2015 ) as well as the passage of the distal end of the stent through a tightly stenosed common carotid artery origin. Conversely, the transfemoral approach may be unsuccessful in traversing the CCA lesion, particularly if it is flush with the aortic arch.…”

Supraaortik multiple stenozlarda eş zamanlı balon anjiyoplasti ve stent implantasyonu

“…Endovasküler tedavinin daha az invaziv olması en önemli avantajı olmakla birlikte, işlemin komplikasyon oranları halâ istenilen seviyede değildir. Özellikle aortik arkdaki damarlarında çoklu stenoz bulunan olgularda eş zamanlı yapılan çoklu girişimsel işlemler istenmeyen olaylara neden olabilmektedir [5][6]…”