Percutaneous Superficial Temporal Artery Access for Carotid Artery Stenting in Patients With a Hostile Aortic Arch

Abstract

Purpose To describe an entirely percutaneous treatment for carotid artery stenting in a type IIa aortic arch via the superficial temporal artery (STA) for through-and-through guidewire access. Technique The technique is demonstrated in an 83-year-old man status post left carotid endarterectomy 3 months prior who presented with 2.5 hours of confusion and dysphasia following diagnostic carotid arteriography. The patient was known to have a type IIa bovine aortic arch and a severe 70% stenosis of the left internal carotid artery. The patient was referred for carotid artery stenting by his vascular surgeon. Due to the bovine arch, a percutaneous ultrasound-guided approach via the STA for through-and-through wire access facilitated carotid artery stenting from the right common femoral artery. The procedure was successful, and follow-up duplex ultrasound confirmed patency of the STA the next day. Conclusion A percutaneous ultrasound-guided STA access can help facilitate transfemoral carotid artery stenting in an otherwise difficult type IIa aortic arch setting.

Difficult catheter access to the occluded vessel during endovascular treatment of acute ischemic stroke is associated with worse clinical outcome

“…In other elective endovascular procedures, several inventive strategies have been described to overcome these difficulties 18 19. The problem becomes very important in the acute stroke setting where time is crucial, and impossibility or delay in catheter delivery may lead to death or disability.…”

Challenging Carotid Intervention After Total Arch Rerouting and Hybrid Zone 0 Elephant Trunk Repair for a Complicated Type A Aortic Dissection

“…We were hesitant about cannulating or sewing a graft on a potentially dissected artery. There were ingenious reports about the use of the superficial temporal artery to treat carotid lesions in hostile aortic arch either as an adjuvant access for a through-and-through wire technique 10 or solely as the primary access route 11 ; however, those stents used were low-profile bare stents in contrast to the relatively bulky covered stent that was mandatory in this patient.…”

Superficial temporal artery access for carotid artery stenting: A case report

“…In some selected cases, due to the small caliber of the vessel, it is much more prone to vasospasm. 6 , 7 During the puncture facial nerve must be avoided, especially in case of an inferior approach. Unfortunately, in the case of interventions performed from this injection point, there is also the risk of retrograde embolization from the ECA into the ICA.…”