Andrew A Fanous1,2, Parham Yashar3, Ashish Sonig1,2, Amanda Zakeri4, Kenneth V Snyder2,5,6,7, Elad I Levy2,6,7,8, Jason M Davies2,6,7,9,10, Adnan H Siddiqui2,6,7,8,10. 1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. 2. Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health; Buffalo, NY, USA. 3. KB Surgical Center, Beverly Hills, CA, USA. 4. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. 5. Departments of Neurosurgery and Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. 6. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, State University of New York, Buffalo, NY, USA. 7. Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA. 8. Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. 9. Departments of Neurosurgery and Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. 10. Jacobs Institute, Buffalo, NY, USA.
Abstract
BACKGROUND: The treatment of tandem lesions involving severe stenosis of the internal carotid artery with concomitant stenosis of the ipsilateral common carotid artery (CCA) origin represents an ongoing challenge. Current options for the treatment of tandem carotid artery origin and bifurcation stenotic lesions include open surgical endarterectomy, endovascular stenting, balloon angioplasty, and hybrid procedures combining both modalities. However, these options are either associated with high peri-operative risks or not always anatomically feasible. CASE DESCRIPTION: We report, for the first time in North America (to the best of our knowledge), an alternative treatment modality that involves obtaining access through a direct carotid cut-down, with serial treatment of the tandem lesions through a combination of retrograde and anterograde endovascular stenting. CONCLUSION: This technique obviates the need for navigating the aortic arch in patients with difficult arch anatomy and permits the use of distal embolic protection devices, thus decreasing the risk of peri-operative ischemic events.
BACKGROUND: The treatment of tandem lesions involving severe stenosis of the internal carotid artery with concomitant stenosis of the ipsilateral common carotid artery (CCA) origin represents an ongoing challenge. Current options for the treatment of tandem carotid artery origin and bifurcation stenotic lesions include open surgical endarterectomy, endovascular stenting, balloon angioplasty, and hybrid procedures combining both modalities. However, these options are either associated with high peri-operative risks or not always anatomically feasible. CASE DESCRIPTION: We report, for the first time in North America (to the best of our knowledge), an alternative treatment modality that involves obtaining access through a direct carotid cut-down, with serial treatment of the tandem lesions through a combination of retrograde and anterograde endovascular stenting. CONCLUSION: This technique obviates the need for navigating the aortic arch in patients with difficult arch anatomy and permits the use of distal embolic protection devices, thus decreasing the risk of peri-operative ischemic events.
Authors: David E Allie; Chris J Hebert; Mitchell D Lirtzman; Charles H Wyatt; Mohamed H Khan; Muhammad A Khan; Peter S Fail; Gary A Chaisson; V Antoine Keller; Dennis A Vitrella; Sonja D Allie; Adam A Allie; Elena V Mitran; Craig M Walker Journal: J Endovasc Ther Date: 2004-06 Impact factor: 3.487
Authors: Kathleen J Ozsvath; Sean P Roddy; R Clement Darling; John Byrne; Paul B Kreienberg; Daniel Choi; Philip S K Paty; Benjamin B Chang; Manish Mehta; Dhiraj M Shah Journal: J Vasc Surg Date: 2003-03 Impact factor: 4.268
Authors: Travis M Dumont; Jorge L Eller; Maxim Mokin; Kenneth V Snyder; L Nelson Hopkins; Elad I Levy; Adnan H Siddiqui Journal: J Neurointerv Surg Date: 2012-11-02 Impact factor: 5.836