Transfemoral endovascular treatment of atherosclerotic stenotic lesions of the left common carotid artery ostium: case series and review of the literature

Abstract

In our experience, transfemoral stenting of stenotic LCCAO lesions is feasible and no permanent neurological or cardiopulmonary sequelae occurred in 14 patients treated with this technique.

Acute Ischemic Stroke due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting

“…Surgical treatment of CCA ostial lesions has been performed with bypass surgery (subclaviancarotid, carotid-carotid), although this procedure requires thoracotomy or median sternotomy and carries a perioperative mortality of approximately 6% [12]. Thus, endovascular approaches have become increasingly preferable.…”

“…Recent reports on stenting of the CCA ostium employ techniques similar to those used in our first case [3,12]. In brief, a diagnostic catheter is used to select the involved CCA, carefully traversing the ostial lesion.…”

Stenting of the Stenotic Common Carotid Artery Ostium by the Buddy Wire Technique: A Case Report

“…To the present, techniques including the coaxial use of a distal protection device and a 0.014-inch guidewire, 10) penetration of the stenosed area using a guiding catheter, 11) and the use of two distal balloon protection devices 12) have been reported. From the viewpoint of prevention of distal embolism as a complication, passing the guiding catheter through the stenosed area should be avoided.…”

“…[2][3][4][5][6][7][8][9][10][11][12] While reports restricting the target to the common carotid artery lesions are few, Linni et al 9) observed the absence of cranial nerve damage and lymphorrhea as advantages of endovascular treatment in a study restricted to 52 patients with common carotid artery lesions and recommended endovascular treatment as the first choice and other direct surgical procedures as useful alternatives. Van de Weijer et al 18) reported that lesion cross was impossible in 4 of the 144 patients who underwent endovascular treatment, particularly, in 2 of the 5 patients with occluded lesions.…”

“…To the present, various techniques including bypass, transposition, ring-stripping retrograde CEA, retrograde percutaneous transluminal angioplasty (PTA), CAS, and transfemoral PTA or CAS have been reported, but all these procedures are more complex than CEA or CAS for stenosis of the internal carotid artery origin. [2][3][4][5][6][7][8][9][10][11][12] In performing transfemoral CAS, securing of the stability of the guiding catheter poses a greater problem because of the more proximal location of the lesion, and various techniques for catheter stabilization have been developed. [10][11][12] We performed CAS with the buddy wire technique 13) and a distal filter protection device for a stenotic lesion at the origin of the common carotid artery and obtained a favorable outcome.…”