title: Carotid Artery Stenting in a Patient With a Continuous-Flow Left Ventricular Assist Device.
abstract: OBJECTIVE
  To demonstrate the safety and feasibility of carotid artery stenting (CAS) in a patient with a continuous-flow left ventricular assist device (LVAD).
  
  
  METHODS
  A 54-year-old woman with a LVAD was referred for a 90% stenosis of the right internal carotid artery (ICA). The patient was offered CAS, and oral anticoagulant was not discontinued in the periprocedural period. Because of absent arterial pulses, percutaneous transfemoral access was obtained under ultrasound guidance. Particular attention was paid to cannulation of the innominate artery; a 7-F guiding catheter was advanced from the descending aorta into the innominate artery under road-mapping, avoiding maneuvers in the ascending aorta where the outflow Dacron graft of the LVAD was anastomosed. To avoid cerebral flow modifications, the Angioguard RX was used as the cerebral protection device rather than other devices such as the flow reversal or flow-clamping systems. At this point, CAS was performed in a standard fashion using the 7×30-mm Precise ProRX stent. The computed tomography angiogram at 6 months showed patency of the stented right ICA.
  
  
  CONCLUSIONS
  With adequate planning, CAS appears feasible in patients with a LVAD.
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy mikpia79@hotmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Squizzato
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Grego
authors.affiliation: Cardiac Surgery, Padova University, School of Medicine, Padova, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bottio
authors.affiliation: Cardiac Surgery, Padova University, School of Medicine, Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Antonello
mesh_terms: D017130:Angioplasty / Q000295:instrumentation*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D000072226:Computed Tomography Angiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left
keywords: carotid artery stent; carotid stenosis; cerebral protection; internal carotid artery; left ventricular assist device