Intraoperative innominate and common carotid intervention combined with carotid endarterectomy: a "true" endovascular surgical approach.
OBJECTIVE
To report the technique of carotid endarterectomy (CEA) combined with retrograde balloon angioplasty and stenting of proximal "tandem" lesions in the supra-aortic trunk.


METHODS
Intraoperative techniques in 34 patients with 23 left common carotid artery (CCA) and 11 innominate artery lesions included general anesthesia, low-dose dextran, prosthetic patching, selective shunting, 8-F sheath entry into the native CCA before the CEA, manual CCA sizing, and balloon-expandable stent placement after predilation. The technique has a high procedural success rate (97%) and appears durable. Over a mean 34-month follow-up, 2 >70% ostial CCA restenoses were found at 24 months.


CONCLUSIONS
Intraoperative innominate or left CCA balloon angioplasty/stenting combined with carotid endarterectomy is safe, effective, and durable.
Allie
David E
DE
Cardiovascular Institute of the South, Southwest Medical Center, Lafayette, Louisiana, USA.
Hebert
Chris J
CJ
Lirtzman
Mitchell D
MD
Wyatt
Charles H
CH
Khan
Mohamed H
MH
Khan
Muhammad A
MA
Fail
Peter S
PS
Chaisson
Gary A
GA
Keller
V Antoine
VA
Vitrella
Dennis A
DA
Allie
Sonja D
SD
Allie
Adam A
AA
Mitran
Elena V
EV
Walker
Craig M
CM
D000792:Angiography; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy; D016894:Endarterectomy, Carotid / Q000295:instrumentation*; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome