Tandem Balloon Protection during Emergency Carotid Artery Stenting of a Stenotic ICA Lesion with Intraluminal Thrombus

Imai, Kyoichi; Makino, Masahiro; Niwa, Fumitoshi; Takegami, Tsutomu; Koike, Hironori; Azuma, Yumiko; Oshima, Fumiko; Oda, Kenichiro; Kakita, Kiyohito

doi:10.1177/152660280701400214

Cited by 11 publications

(3 citation statements)

References 11 publications

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“…However, two subsequent series of 9 ICT patients 13 and 6 acute stroke patients with ICT 14 noted a 0% risk of stroke/death following early CAS. Taken together, these three small case series 13,17 and other individual case reports 12,17 suggest that early CAS for treatment of patients with symptomatic ICT may be a reasonable approach, though the number of reported cases remains small. However, it should be noted that the degree of stenosis in many of these patients maybe minimal once the thrombus has lysed.…”

Section: Discussionmentioning

confidence: 73%

Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation

Vellimana¹,

Kadkhodayan

Rich

et al. 2013

JNS

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Background Optimal treatment for patients with symptomatic intraluminal carotid thrombus (ICT) remains poorly defined. Methods We performed a retrospective chart review of patients presenting to our institution between 2001 and 2011 with symptomatic ICT. Results Twenty-four patients (16 males, 8 females) with ICT presented with ischemic stroke (n=18) or TIA (n=6). All were treated initially with anticoagulation ± antiplatelet drugs. Eight of these patients had no or mild carotid stenosis on initial angiography and were treated with medical management alone. The remaining 16 patients had moderate or severe carotid stenosis on initial angiography. Of these, 10 underwent delayed revascularization (endarterectomy, n=8; angioplasty and stenting, n=2), 2 refused revascularization, and 4 were treated with medical therapy alone. One patient had multiple TIAs despite medical therapy and eventually underwent CEA; the remaining 23 patients had no TIAs. No patient suffered ischemic or hemorrhagic stroke while on anticoagulation, during the perioperative period or in long-term follow up; one patient died of an unrelated condition (mean follow-up = 16.4 months). Conclusion Our results suggest that initial anticoagulation of symptomatic ICT results in a low rate of recurrent ischemic events and that carotid revascularization, if indicated, can be safely performed in a delayed manner.

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Section: Discussionmentioning

confidence: 73%

Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation

Vellimana¹,

Kadkhodayan

Rich

et al. 2013

JNS

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“…The experimental setup used is easily applicable as a proximal protection technique for emergent stenting procedures during thrombectomy for ischemic stroke (Cohen et al 2015 ; Lescher et al 2015 ). It could also be used for emergent carotid stenting procedures with intraluminal thrombus (Imai et al 2007 ).…”

Section: Discussionmentioning

confidence: 99%

Achievable aspiration flow rates with large balloon guide catheters during carotid artery stenting

et al. 2020

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Background Emergency carotid artery stenting (CAS) is a frequent endovascular procedure, especially in combination with intracranial thrombectomy. Balloon guide catheters are frequently used in these procedures. Our aim was to determine if mechanical aspiration through the working lumen of a balloon occlusion catheter during the steps of a carotid stenting procedure achieve flow rates that may lead to internal carotid artery (ICA) flow reversal which consecutively may prevent distal embolism. Methods Aspiration experiments were conducted using a commercially available aspiration pump. Aspiration flow rates/min with 6 different types of carotid stents inserted into a balloon guide catheter were measured. Measurements were repeated three times with increasing pressure in the phantom. To determine if the achieved aspiration flow rates were similar to physiologic values, flow rates in the ICA and external carotid artery (ECA) in 10 healthy volunteers were measured using 4D-flow MRI. Results Aspiration flow rates ranged from 25 to 82 mL/min depending on the stent model. The pressure in the phantom had a significant influence on the aspiration volume. Mean blood flow volumes in volunteers were 210 mL/min in the ICA and 101 mL/min in the ECA. Conclusions Based on the results of this study, flow reversal in the ICA during common carotid artery occlusion is most likely achieved with the smallest diameter stent sheath and the stent model with the shortest outer stent sheath maximum diameter. This implies that embolic protection during emergency CAS through aspiration is most effective with these models.

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“…This method was reported to have been used for removing endovascular thrombi of the carotid artery. 8,9) Recently, in EVT for embolism and atherosclerotic occlusion of lower extremity arteries, hybrid revascularization by a combined approach of cardiovascular surgery and cardiology has been reported to be useful, and this approach is proposed by the guidelines for lower extremity revascularization by the European Society of Cardiology. 10) Since AEO-BCA is a disorder of the borderline area between neurology and cardiology, pre-and intraoperative conferences between experts of the two disciplines are also considered necessary in EVT.…”

Section: Discussionmentioning

confidence: 99%

A Case of Acute Embolic Occlusion of the Brachiocephalic Artery Recanalized with Endovascular Thrombectomy

Okamoto

Imai

Hamanaka

et al. 2017

JNET

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Objective: Endovascular treatment of a patient with acute embolism of the brachiocephalic artery (BCA) is reported. Case Presentations:A 70-year-old woman presenting with weakness of the right upper extremity was transferred to our hospital due to acute embolism of the BCA. After the right brachial artery was secured by direct cardiovascular surgery, a balloon guidewire was inserted through the femoral artery and advanced near the thrombus in the BCA, and the balloon at its tip was inflated in the right internal carotid artery. Immediately after this, the thrombus in the BCA migrated to the right common carotid artery and right subclavian artery. The two vessels could be recanalized by endovascular treatment via a guide catheter and via the right brachial artery, respectively. Conclusion:In endovascular treatment for acute embolization of the BCA, the methods for thrombus retrieval and distal protection have not been established, and the concurrent direct surgery and cooperation by a cardiologist are indispensable.Keywords▶ cardiogenic embolism, embolic occlusion of brachiocephalic artery, endovascular thrombectomy, balloon-guide catheter, fogarty catheter

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Tandem Balloon Protection during Emergency Carotid Artery Stenting of a Stenotic ICA Lesion with Intraluminal Thrombus

Abstract: This experience suggests that emergency CAS with tandem balloon protection is a potential treatment for a stenotic lesion with an intraluminal thrombus in patients with fluctuating stroke.

Cited by 11 publications

References 11 publications

Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation

Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation

Achievable aspiration flow rates with large balloon guide catheters during carotid artery stenting

A Case of Acute Embolic Occlusion of the Brachiocephalic Artery Recanalized with Endovascular Thrombectomy

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