Junpei Koge1,2, Tomonori Iwata3, Tetsuya Hashimoto4,3, Shigehisa Mizuta4, Yukihiko Nakamura5, Eri Tanaka4, Masakazu Kawajiri4, Shun-Ichi Matsumoto6, Takeshi Yamada4. 1. Department of Neurology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka City, Fukuoka, 810-0001, Japan. j.kouge@gmail.com. 2. Department of Vascular Neurology, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan. j.kouge@gmail.com. 3. Department of Vascular Neurology, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan. 4. Department of Neurology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka City, Fukuoka, 810-0001, Japan. 5. Department of Neurosurgery, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan. 6. Department of Radiology, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan.
Abstract
PURPOSE: Transbrachial carotid artery stenting (TB-CAS) is performed as an alternative procedure for patients with hostile vascular anatomy of the aortic arch and aortic or peripheral artery disease. Proximal protection during TB-CAS is not generally feasible because a small size of the brachial artery may preclude using a large-diameter sheath introducer. We, herein present a novel method that enables proximal protection during TB-CAS by sheathless navigation of a 9-F balloon-guiding catheter equivalent to a 7-F sheath. METHODS: We analyzed eight consecutive patients who underwent TB-CAS with proximal protection using the sheathless method from April 2016 to June 2017. Relevant demographic, radiographic, and procedural features were retrospectively reviewed. RESULTS: We performed TB-CAS using our method for five patients with a bovine or type 3 aortic arch, for one patient with combined peripheral artery disease, and for two patients with a type 1 or 2 aortic arch. We successfully navigated the balloon-guiding catheter via the brachial artery and performed CAS under proximal flow control in all patients. However, we experienced kinking and exchange of the balloon-guiding catheter in one patient and a periprocedural thromboembolic event occurred. A pseudoaneurysm at the access site developed in one patient. CONCLUSION: TB-CAS with proximal embolic protection using the sheathless method is feasible and may provide an alternative approach in carefully selected patients who have difficult anatomy in the transfemoral approach and plaques with a high risk of distal embolization.
PURPOSE: Transbrachial carotid artery stenting (TB-CAS) is performed as an alternative procedure for patients with hostile vascular anatomy of the aortic arch and aortic or peripheral artery disease. Proximal protection during TB-CAS is not generally feasible because a small size of the brachial artery may preclude using a large-diameter sheath introducer. We, herein present a novel method that enables proximal protection during TB-CAS by sheathless navigation of a 9-F balloon-guiding catheter equivalent to a 7-F sheath. METHODS: We analyzed eight consecutive patients who underwent TB-CAS with proximal protection using the sheathless method from April 2016 to June 2017. Relevant demographic, radiographic, and procedural features were retrospectively reviewed. RESULTS: We performed TB-CAS using our method for five patients with a bovine or type 3 aortic arch, for one patient with combined peripheral artery disease, and for two patients with a type 1 or 2 aortic arch. We successfully navigated the balloon-guiding catheter via the brachial artery and performed CAS under proximal flow control in all patients. However, we experienced kinking and exchange of the balloon-guiding catheter in one patient and a periprocedural thromboembolic event occurred. A pseudoaneurysm at the access site developed in one patient. CONCLUSION:TB-CAS with proximal embolic protection using the sheathless method is feasible and may provide an alternative approach in carefully selected patients who have difficult anatomy in the transfemoral approach and plaques with a high risk of distal embolization.
Authors: Piero Montorsi; Stefano Galli; Paolo M Ravagnani; Simone Tresoldi; Giovanni Teruzzi; Luigi Caputi; Daniela Trabattoni; Franco Fabbiocchi; Giuseppe Calligaris; Luca Grancini; Alessandro Lualdi; Stefano de Martini; Antonio L Bartorelli Journal: J Endovasc Ther Date: 2016-06-06 Impact factor: 3.487
Authors: Jay S Yadav; Mark H Wholey; Richard E Kuntz; Pierre Fayad; Barry T Katzen; Gregory J Mishkel; Tanvir K Bajwa; Patrick Whitlow; Neil E Strickman; Michael R Jaff; Jeffrey J Popma; David B Snead; Donald E Cutlip; Brian G Firth; Kenneth Ouriel Journal: N Engl J Med Date: 2004-10-07 Impact factor: 91.245
Authors: Konstantinos Stavroulakis; Marco V Usai; Giovanni Torsello; Arne Schwindt; Arne Stachmann; Efthymios Beropoulis; Theodosios Bisdas Journal: J Endovasc Ther Date: 2016-04-01 Impact factor: 3.487