Cerebral protection during retrograde carotid artery stenting for proximal carotid artery stenosis: technical note.
Carotid artery stenting for carotid bifurcation stenosis usually uses the transfemoral approach. However, in patients with proximal common carotid artery (CCA) stenosis, the guiding catheter is difficult to introduce into the narrow origin of the CCA without risking cerebral embolization before activation of the protection device. A technique of cerebral protection by internal carotid artery (ICA) clamping with or without simultaneous external carotid artery (ECA) clamping was used to treat patients with proximal CCA stenosis by the retrograde direct carotid approach. The carotid bifurcation was surgically exposed and retrograde catheterization was performed to approach the stenosis. The ICA was clamped during angioplasty and stenting to avoid cerebral embolization. The ECA was clamped simultaneously if any extracranial-intracranial anastomosis was present. None of five patients treated with this technique experienced ischemic complications attributable to this technique.
Tsutsumi
Masanori
M
Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan.
Kazekawa
Kiyoshi
K
Onizuka
Masanari
M
Kodama
Tomonobu
T
Nii
Kouhei
K
Aikawa
Hiroshi
H
Iko
Minoru
M
Tomokiyo
Makoto
M
Matsubara
Shuko
S
Tanaka
Akira
A
D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D017536:Carotid Artery, Common / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002342:Carotid Artery, External / Q000601:surgery; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods / Q000592:standards; D002533:Cerebral Angiography; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D015607:Stents; D013525:Surgical Instruments / Q000592:standards; D013537:Sutures / Q000592:standards; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods*