Endovascular Treatment of Tandem Lesions of the Carotid Arteries.

Markatis, Fotis; Sfyroeras, George S.; Moulakakis, Konstantinos G.; Kakisis, John D.; Brountzos, Elias; Liapis, Christos D.

doi:10.1016/j.avsg.2013.09.021

Cited by 11 publications

(12 citation statements)

References 16 publications

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“…1 Endovascular interventions for the stenoses include an anterograde transfemoral approach and a retrograde transcarotid approach by arteriotomy either before or after the carotid endarterectomy (CEA). 1,3 An anterograde transfemoral approach for those stenoses could have technical difficulties because of the poor stability of the guiding catheter resulting from anatomical Figure 1. Three-dimensional computed tomography image (a) and two angiograms of the common carotid artery (b, the left anterior oblique view; c, the left lateral view) demonstrated the tandem stenoses at the proximal common and internal carotid arteries on the left side, the stenotic rates of which were 70% and 80%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…1 Recently, a total endovascular approach for tandem carotid lesions is scarcely reported. 2,3 Alexandrescu et al initially reported tandem carotid lesions treated with antero and retrograde stenting under a filter EPD through a small cervical cut-down and dissection in the case accompanying a complete bilateral iliac artery occlusion. 2 Markatis et al reported five patients treated endovascularly, and transfemoral stenting for the CCA lesions varies among three conditions including ostial, mid-portion and distal-portion of the CCA.…”

Section: Discussionmentioning

confidence: 99%

“…2 Markatis et al reported five patients treated endovascularly, and transfemoral stenting for the CCA lesions varies among three conditions including ostial, mid-portion and distal-portion of the CCA. 3 Catheterisation for the ostial and mid-carotid lesions of the CCA is performed with the guiding catheter followed by the passage of the 0.035-inch guidewire, directed towards the external carotid artery. In these cases, stenting of the CCA is performed without the use of a EPD.…”

Section: Discussionmentioning

confidence: 99%

“…Stenotic lesions involving the proximal common carotid artery (CCA) require unique management, particularly when a disease of the internal carotid artery (ICA) bifurcation coexists. [1][2][3] Surgical treatment of stenosis at the proximal CCA with a transthoracic approach is highly invasive, and its combined perioperative stroke/death rate has been reported to be as high as 16%. 4 Extrathoracic bypass procedures have improved clinical results, but complication rates still remain high.…”

Section: Introductionmentioning

confidence: 99%

“…5 Favourable treatment outcomes have recently been achieved through advancements in endovascular devices and techniques. [1][2][3]6,7 However, transfemoral endovascular stenting for stenosis at the proximal CCA is technically challenging because of the difficulty in overpassing the catheters through the lesion resulting from the poor stability of the guiding catheter. We report a case of tandem stenoses at the proximal CCA and ICA treated with carotid artery stenting (CAS) using a sheath guide (SG) designed for transbrachial carotid cannulation.…”

Section: Introductionmentioning

confidence: 99%

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A case of tandem stenoses at the proximal common and internal carotid arteries treated with transbrachial stenting: a case report

et al. 2018

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The transfemoral approach is a common technique for carotid artery stenting. However, it has the risk of distal embolism when stenting for a stenosis of the proximal common carotid artery because of poor stability of the guiding catheter resulting in difficulty in setting the embolic protection device prior to stenting. We present a novel therapeutic approach and technique for the treatment of tandem carotid stenoses including the proximal common carotid artery. A 63-year-old man presented with double stenoses at the common carotid artery and internal carotid artery. We used a transbrachial sheath guide that had a 6 Fr (2.24 mm, 0.088 inch) internal diameter and was 90 cm long, and was specifically designed for direct cannulation to the common carotid artery, like a modified Simmons catheter. Because the sheath guide positioned in the aortic arch made it possible to introduce safely the embolic protection device distal to the internal carotid artery stenosis without touching the plaque at the stenosis with no use of any coaxial catheters or guidewires, carotid artery stenting for tandem stenoses could be successfully carried out. The postoperative course was uneventful. In carotid artery stenting, especially for stenosis of the proximal common carotid artery, the sheath guide designed for transbrachial carotid cannulation was useful in stenting the tandem carotid stenoses.

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Section: Discussionmentioning

confidence: 99%