title: Flow reversal for proximal neuroprotection during endovascular management of critical symptomatic carotid artery stenosis coexisting with ipsilateral external carotid artery occlusion.
abstract: OBJECTIVE
  To report the utility of proximal brain protection by flow reversal in endovascular management of critical internal carotid artery (ICA) stenosis coexisting with ipsilateral external carotid artery (iECA) occlusion.
  
  
  METHODS
  Four patients with a symptomatic, critical ICA stenosis (in-stent restenosis in one) and iECA occlusion were admitted for carotid artery stenting (CAS). In all cases, the stenosis severity and high-risk lesion morphology precluded the use of filter protection. The "tailored" CAS algorithm indicated that a proximal anti-embolism system should be used to maximize the potential for effective neuroprotection. The flow reversal system, which consists of an independent guiding sheath balloon positioned in the common carotid artery (CCA) and an iECA balloon-wire, was employed, using the CCA balloon only. The system was well-tolerated, and the CAS procedures were uneventful.
  
  
  CONCLUSIONS
  Due to a unique design with separate CCA and iECA balloons, the flow reversal system can be used for proximal neuroprotection during CAS in severe, symptomatic ICA lesions coexisting with iECA occlusion.
authors.affiliation: Department of Cardiac and Vascular Diseases, Jagiellonian University, Krakow, Poland. kardio@kki.krakow.pl
authors.forename: Piotr
authors.initials: P
authors.lastname: Pieniazek
authors.forename: Piotr
authors.initials: P
authors.lastname: Musialek
authors.forename: Karolina
authors.initials: K
authors.lastname: Dzierwa
authors.forename: Rafal
authors.initials: R
authors.lastname: Motyl
authors.forename: Mariusz
authors.initials: M
authors.lastname: Trystuła
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Przewlocki
authors.forename: Anna
authors.initials: A
authors.lastname: Kabłak-Ziembicka
authors.forename: Lukasz
authors.initials: L
authors.lastname: Tekieli
authors.forename: Piotr
authors.initials: P
authors.lastname: Paluszek
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Moczulski
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
authors.forename: Wiesława
authors.initials: W
authors.lastname: Tracz
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D002342:Carotid Artery, External / Q000000981:diagnostic imaging / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D016638:Critical Illness; D004867:Equipment Design; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D010477:Perfusion / Q000295:instrumentation / Q000379:methods*; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial