title: The modified 'no touch' technique in the antegrade endovascular approach for left common carotid artery ostial stenosis stenting.
abstract: BACKGROUND
  Open surgery and the retrograde endovascular approach via the distal left common carotid artery (LCCA) have some limitations in LCCA ostial stenosis treatment. The 'no touch' technique used in the renal artery was modified for this situation.
  
  
  METHODS
  Fifteen selective LCCA stenosis patients were treated by the modified 'no touch' technique in the antegrade endovascular approach from March 2013 to March 2016. Thirteen underwent the transfemoral approach and the other two had the transbrachial approach due to a 'bovine aortic arch'. Distal embolic protection devices were used in all cases. Follow-up included a neurological examination, carotid duplex scan, and office interview. Mean follow-up time was 18.2±11.5 months.
  
  
  RESULTS
  The initial technical success rate was 100%. The average procedure time was 84.0±16.3 min. There were no procedure-related deaths. No clinical neurological complications occurred during the in-hospital stay. No incidence of death or major stroke occurred during the follow-up period; 6.7% (1/15) of patients had a contralateral minor stroke, 66.7% (4/6) of symptomatic patients were relieved of initial symptoms, and the rest showed improvement. No patient developed new ipsilateral neurological symptoms and no in-stent restenosis occurred during the follow-up period. These results were confirmed by ultrasound.
  
  
  CONCLUSIONS
  The modified 'no touch' antegrade endovascular technique is a feasible method for treating LCCA ostial lesions with a satisfactory initial success rate, acceptable procedure time, and comparable mid- and long-term results. This technique could be considered as a complementary option for LCCA ostial stenosis in addition to open surgery and the retrograde endovascular approach.
authors.affiliation: Vascular Surgery Department, Capital Medical University Affiliated Anzhen Hospital, Beijing, China.
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Tang
authors.affiliation: Tsinghua University Medical Center, Beijing, China.
authors.forename: Whitney Annie
authors.initials: WA
authors.lastname: Long
authors.affiliation: Vascular Department, Beijng Huaxin Hospital First Hospital of Tsinghua University, Beijing, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Hu
authors.affiliation: Vascular Department, Beijng Huaxin Hospital First Hospital of Tsinghua University, Beijing, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Tang
authors.affiliation: Vascular Department, Beijng Huaxin Hospital First Hospital of Tsinghua University, Beijing, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Vascular Department, Beijng Huaxin Hospital First Hospital of Tsinghua University, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001015:Aortic Arch Syndromes / Q000150:complications / Q000601:surgery; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000453:epidemiology; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
keywords: Cervical; Stenosis; Stent; Stroke; Technique