title: Recanalization of a symptomatic extracranial internal carotid artery near occlusion with proximal and distal protection: technical case report.
abstract: OBJECTIVE
  To describe a novel approach to recanalizing symptomatic extracranial internal carotid artery near occlusion using proximal and distal emboli protection devices.
  
  
  METHODS
  Patients presenting with symptomatic extracranial internal carotid artery near occlusion who underwent endovascular recanalization between October 2004 and July 2005 were included in this study. During these procedures, a 9-French Concentric Balloon Guide Catheter (Concentric Medical, Mountain View, CA) was advanced into the common carotid artery proximal to the site of occlusion. During the prestent angioplasty of the lesion, the proximal balloon was inflated and aspiration was performed. After initial angioplasty and before stent placement, a distal filter protection device was placed in the distal internal carotid artery. Stent placement and repeat angioplasty were performed with both protection devices active. All patients were placed on dual antiplatelet therapy.
  
  
  RESULTS
  There were four patients treated with a mean age of 74 years; three of these four patients were men. All patients had signs of ischemia and carotid occlusion or near occlusion on noninvasive imaging. Three right internal carotid arteries were treated. All patients were successfully recanalized. No procedurally related complications or deaths occurred.
  
  
  CONCLUSIONS
  This series demonstrates the feasibility of recanalization of symptomatic carotid artery occlusion or near occlusion using proximal and distal emboli protection devices. Such an approach may provide an added level of safety during carotid recanalization procedures.
authors.affiliation: Division of Neurosurgery, Neuroendovascular Section, Albany Medical Center, Albany, New York 12208, USA.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Edgell
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
authors.forename: Celso
authors.initials: C
authors.lastname: Agner
authors.forename: Matthew
authors.initials: M
authors.lastname: Adamo
authors.forename: Alan S
authors.initials: AS
authors.lastname: Boulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D006801:Humans; D008297:Male; D016896:Treatment Outcome