Combined Angioplasty Technique of the Carotid Territory and Supra-Aortic Trunk by Double Access (Cervical and Limbs) for Tandem Lesions.
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
22
03
2020
revised:
13
04
2020
accepted:
16
04
2020
pubmed:
28
4
2020
medline:
24
11
2020
entrez:
28
4
2020
Statut:
ppublish
Résumé
The carotid stent angioplasty (CAS) has been the main option for patients with high cardiovascular risk and carotid stenosis. The common femoral artery is still the most used access site; however, the aortic arch manipulation is a critical moment for cerebral embolization. Carotid transcervical access should be considered as a good alternative access route for CAS. Tandem lesions combining supra-aortic trunks and ipsilateral carotid bulb critical stenosis pose a great challenge for the vascular surgeon. This is a retrospective descriptive study based on medical records of our institution. We report 2 cases of complex cerebral vascular insufficiency and discuss therapeutic options and strategies to protect the cerebrovascular territory avoiding microembolization, as well as demonstrate an alternative and safe total endovascular approach for those cases. We describe the approach of 2 complex cerebral vascular insufficiency cases: case 1, a 63-year-old male with previous ischemic stroke, right internal carotid artery (ICA) occlusion, left ICA stenosis >70%, and critical stenosis of the origin of common carotid artery (CCA); case 2, a 68-year-old female with previous ischemic stroke, left ICA occlusion, brachiocephalic trunk critical stenosis, hypoplastic right vertebral artery, and aortobi-iliac chronic occlusion. In both cases reported here a challenging solution was chosen, little described in the literature, with cerebral filter protection as the first step. In addition, a literature review was performed to discuss the different approach options for tandem injuries of the supra-aortic trunk and carotid bulb. Our initial experience with total endovascular treatment of complex tandem lesions of the carotid territory and supra-aortic trunks show that transcervical access, coupled with distal protection filter device on the first step, is a safe and effective technique for preventing neurological events.
Sections du résumé
BACKGROUND
BACKGROUND
The carotid stent angioplasty (CAS) has been the main option for patients with high cardiovascular risk and carotid stenosis. The common femoral artery is still the most used access site; however, the aortic arch manipulation is a critical moment for cerebral embolization. Carotid transcervical access should be considered as a good alternative access route for CAS. Tandem lesions combining supra-aortic trunks and ipsilateral carotid bulb critical stenosis pose a great challenge for the vascular surgeon.
METHODS
METHODS
This is a retrospective descriptive study based on medical records of our institution. We report 2 cases of complex cerebral vascular insufficiency and discuss therapeutic options and strategies to protect the cerebrovascular territory avoiding microembolization, as well as demonstrate an alternative and safe total endovascular approach for those cases.
RESULTS
RESULTS
We describe the approach of 2 complex cerebral vascular insufficiency cases: case 1, a 63-year-old male with previous ischemic stroke, right internal carotid artery (ICA) occlusion, left ICA stenosis >70%, and critical stenosis of the origin of common carotid artery (CCA); case 2, a 68-year-old female with previous ischemic stroke, left ICA occlusion, brachiocephalic trunk critical stenosis, hypoplastic right vertebral artery, and aortobi-iliac chronic occlusion. In both cases reported here a challenging solution was chosen, little described in the literature, with cerebral filter protection as the first step. In addition, a literature review was performed to discuss the different approach options for tandem injuries of the supra-aortic trunk and carotid bulb.
CONCLUSIONS
CONCLUSIONS
Our initial experience with total endovascular treatment of complex tandem lesions of the carotid territory and supra-aortic trunks show that transcervical access, coupled with distal protection filter device on the first step, is a safe and effective technique for preventing neurological events.
Identifiants
pubmed: 32339677
pii: S0890-5096(20)30348-4
doi: 10.1016/j.avsg.2020.04.029
pii:
doi:
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
570.e9-570.e15Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.