title: The clinical results of transcervical carotid artery stenting and frequency chosen as the approach route of carotid artery stenting in 1,067 consecutive cases.
abstract: BACKGROUND
  Carotid artery stenting (CAS) is generally performed via a transfemoral approach. A transbrachial approach is usually chosen as an alternative when CAS via a transfemoral approach is difficult. At our institutions, a transcervical approach is chosen when the previous two approach routes are not available. We reviewed CAS cases treated via the transcervical route in our 1,067 CAS series to investigate the safety, feasibility, and frequency of this procedure as an approach route of CAS.
  
  
  METHODS
  We performed 1,067 CAS procedures in 1,067 consecutive cases between December 2002 and June 2011. Initially, a transfemoral route was chosen, and secondarily a transbrachial route, the last choice was a transcervical route. A transbrachial approach was chosen in 96 (9.0%) cases and a transcervical approach in ten (0.9%). We reviewed the characteristics and outcomes of CAS performed via a transcervical approach.
  
  
  RESULTS
  CAS was successfully performed on all ten transcervical-approach patients. Eight procedures were performed under local anesthesia and two under general anesthesia. Perioperative morbidity and mortality were both 0%. The modified Rankin scale (mRS) showed no deterioration at 3 months except for one case whose mRS became five because of an embolic stroke after aortic valve replacement.
  
  
  CONCLUSIONS
  CAS via a transcervical approach was safe and feasible, and its frequency chosen as an approach route was 0.9%. This procedure can be an alternative to transfemoral or transbrachial approaches when CAS via either of these approaches is too difficult.
authors: Department of Neurosurgery, Japanese Red Cross Society Wakayama Medical Center, 20-banchi, 4-chome, Komatsubara-dori, Wakayama city, Wakayama, Japan 640-8558. ymatsuda0517@yahoo.co.jp
authors: Yoshikazu
authors: Y
authors: Matsuda
authors: Tomoaki
authors: T
authors: Terada
authors: Osamu
authors: O
authors: Masuo
authors: Hiroyuki
authors: H
authors: Matsumoto
authors: Kousuke
authors: K
authors: Ohshima
authors: Tomoyuki
authors: T
authors: Tsumoto
authors: Mitsuharu
authors: M
authors: Tsuura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002339:Carotid Arteries / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome