Faculty Collaboration Database

Endovascular stenting of supra-aortic lesions using a transcarotid retrograde approach and flow reversal: A multicenter case series. J Vasc Surg 2020 Jun;71(6):2012-2020.e18

Date

11/20/2019

Pubmed ID

31740187

DOI

10.1016/j.jvs.2019.08.269

Scopus ID

2-s2.0-85075460630 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

OBJECTIVE: Endovascular treatment has largely replaced open reconstruction of proximal brachiocephalic and left common carotid ostial arterial stenoses. The objective of this study was to report the technical feasibility and safety of a flow-based embolic protection system in stenting of single and tandem stenotic lesions of supra-aortic arch vessels.

METHODS: All cases used flow-based neuroprotection by the ENROUTE Transcarotid Neuroprotection System (Silk Road Medical, Sunnyvale, Calif). Case specifics, such as the stents used, the details of flow-based neuroprotection, the order in which lesions were treated, and the case-specific exceptions, are detailed in the body of the publication. The primary end point of this study was the occurrence of stroke or transient ischemic attack.

RESULTS: Sixteen patients (12 women) with an average age of 68 years (range, 54-83 years) underwent endovascular stenting to treat single (11 patients) or tandem (5 patients) stenotic lesions of supra-aortic arch vessels. A total of 21 lesions were treated: 7 in the innominate artery, 1 in the right common carotid artery, 8 in the left common carotid artery, and 5 in the internal carotid artery (tandem cases). Eleven patients (69%) were symptomatic, and the stenoses of the five asymptomatic patients were identified during routine workup for comorbidities. Technical success was obtained in all cases. There were no strokes or transient ischemic attacks during the 30 days after the procedure. Minor complications included a minor wound dehiscence that healed secondarily without sequelae and a hematoma at the neck incision that resolved spontaneously without further intervention.

CONCLUSIONS: The use of a transcarotid retrograde approach with flow-based neuroprotection is technically feasible for the endovascular stenting of single and tandem stenotic lesions of the supra-aortic arch vessels. These data further support the advantages of a transcarotid approach and flow-based neuroprotection to minimize the risk of intraoperative complications and embolic events during and after the procedure.

Author List

Balceniuk MD, Hosn MA, Corn RS, DerDerian T, Grimsley BR, Long P, Moore WS, Rossi PJ, Shakir HJ, Siddiqui AH, Spadone DP, Waqas M, Stoner MC

Author

Peter J. Rossi MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Arterial Occlusive Diseases
Brachiocephalic Trunk
Carotid Stenosis
Cerebrovascular Circulation
Embolic Protection Devices
Endovascular Procedures
Feasibility Studies
Female
Humans
Ischemic Attack, Transient
Male
Middle Aged
Retrospective Studies
Risk Factors
Stents
Stroke
Time Factors
Treatment Outcome
United States