Transcervical approach with protective flow reversal for carotid angioplasty and stenting

Iraklis I Pipinos, Jason M Johanning, Chinh N. Pham, Krishnasamy Soundararajan, Thomas G. Lynch

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Purpose: To report our initial experience using a transcervical approach for carotid angioplasty/stenting (CAS) that employs internal carotid artery (ICA) flow reversal for neuroprotection. Methods: Seventeen patients (15 men; mean age 65 years, range 49-77) with significant carotid stenosis (mean 88%, 8 symptomatic) were treated with protected transcervical CAS. Eleven patients were considered at high risk for carotid endarterectomy; 8 were also considered high risk for transfemoral access (unfavorable aortic arch anatomy or advanced aortoiliac occlusive disease). Anesthesia was based on patient and anesthesiologist preferences. The approach consisted of a 2-cm cutdown over the common carotid artery and placement of a 9-F sheath. ICA flow was reversed and shunted into the jugular vein during the carotid intervention. Results: Access and carotid stenting were successful in all cases. Thirteen procedures were performed under general and 4 under local anesthesia. Mean flow reversal time was 34±4 minutes (25 minutes in the last 7 cases). The patients tolerated the procedure well and had no neurological events. Four (23%) patients had significant oozing from the operative site; 2 developed small neck hematomas that were treated conservatively. All patients were discharged on the first postoperative day. There were no deaths, changes in neurological status, or restenosis over a mean follow-up of 12 months (range 1-24). Conclusions: Our initial experience demonstrates that a transcervical approach is a viable alternative for CAS. The procedure can be performed safely, with good initial clinical outcomes. The approach allows carotid flow reversal and emboli protection without introducing neuroprotection devices. The method appears best suited for patients at high risk for endarterectomy and transfemoral access.

Original languageEnglish (US)
Pages (from-to)446-453
Number of pages8
JournalJournal of Endovascular Therapy
Volume12
Issue number4
DOIs
StatePublished - Aug 1 2005

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Angioplasty
Internal Carotid Artery
Endarterectomy
Patient Preference
Carotid Endarterectomy
Carotid Stenosis
Common Carotid Artery
Jugular Veins
Local Anesthesia
Embolism
Thoracic Aorta
Hematoma
Anatomy
Neck
Anesthesia
Equipment and Supplies

Keywords

  • Carotid artery
  • Carotid flow reversal
  • Emboli protection device
  • Stent
  • Transcervical approach

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Transcervical approach with protective flow reversal for carotid angioplasty and stenting. / Pipinos, Iraklis I; Johanning, Jason M; Pham, Chinh N.; Soundararajan, Krishnasamy; Lynch, Thomas G.

In: Journal of Endovascular Therapy, Vol. 12, No. 4, 01.08.2005, p. 446-453.

Research output: Contribution to journalArticle

Pipinos, Iraklis I ; Johanning, Jason M ; Pham, Chinh N. ; Soundararajan, Krishnasamy ; Lynch, Thomas G. / Transcervical approach with protective flow reversal for carotid angioplasty and stenting. In: Journal of Endovascular Therapy. 2005 ; Vol. 12, No. 4. pp. 446-453.
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abstract = "Purpose: To report our initial experience using a transcervical approach for carotid angioplasty/stenting (CAS) that employs internal carotid artery (ICA) flow reversal for neuroprotection. Methods: Seventeen patients (15 men; mean age 65 years, range 49-77) with significant carotid stenosis (mean 88{\%}, 8 symptomatic) were treated with protected transcervical CAS. Eleven patients were considered at high risk for carotid endarterectomy; 8 were also considered high risk for transfemoral access (unfavorable aortic arch anatomy or advanced aortoiliac occlusive disease). Anesthesia was based on patient and anesthesiologist preferences. The approach consisted of a 2-cm cutdown over the common carotid artery and placement of a 9-F sheath. ICA flow was reversed and shunted into the jugular vein during the carotid intervention. Results: Access and carotid stenting were successful in all cases. Thirteen procedures were performed under general and 4 under local anesthesia. Mean flow reversal time was 34±4 minutes (25 minutes in the last 7 cases). The patients tolerated the procedure well and had no neurological events. Four (23{\%}) patients had significant oozing from the operative site; 2 developed small neck hematomas that were treated conservatively. All patients were discharged on the first postoperative day. There were no deaths, changes in neurological status, or restenosis over a mean follow-up of 12 months (range 1-24). Conclusions: Our initial experience demonstrates that a transcervical approach is a viable alternative for CAS. The procedure can be performed safely, with good initial clinical outcomes. The approach allows carotid flow reversal and emboli protection without introducing neuroprotection devices. The method appears best suited for patients at high risk for endarterectomy and transfemoral access.",
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