Result: Endovascular carotid artery revascularization utilizing multiple distal embolic protection strategies: active and passive flow reversal in combination with balloon assisted reperfusion.

Title:
Endovascular carotid artery revascularization utilizing multiple distal embolic protection strategies: active and passive flow reversal in combination with balloon assisted reperfusion.
Authors:
Boulter JH; Cerebrovascular and Endovascular Neurosurgery, Piedmont Atlanta Hospital, Atlanta, GA, United States. Electronic address: jhboulter@gmail.com., Shapiro JD; Department of Anesthesia, Piedmont Atlanta Hospital, Atlanta, GA, United States., Pratt AM; Cerebrovascular and Endovascular Neurosurgery, Piedmont Atlanta Hospital, Atlanta, GA, United States., Viaggio K; Cerebrovascular and Endovascular Neurosurgery, Piedmont Atlanta Hospital, Atlanta, GA, United States., Schuette AJ; Cerebrovascular and Endovascular Neurosurgery, Piedmont Atlanta Hospital, Atlanta, GA, United States., Stiefel MF; Cerebrovascular and Endovascular Neurosurgery, Piedmont Atlanta Hospital, Atlanta, GA, United States.
Source:
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2025 Sep; Vol. 139, pp. 111413. Date of Electronic Publication: 2025 Jun 23.
Publication Type:
Journal Article; Case Reports
Language:
English
Journal Info:
Publisher: Churchill Livingstone Country of Publication: Scotland NLM ID: 9433352 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2653 (Electronic) Linking ISSN: 09675868 NLM ISO Abbreviation: J Clin Neurosci Subsets: MEDLINE
Imprint Name(s):
Publication: <2000->: Edinburgh : Churchill Livingstone
Original Publication: Melbourne, Vic., Australia : Churchill Livingstone, c1994-
MeSH Terms:
Carotid Stenosis*/surgery , Carotid Stenosis*/complications , Endovascular Procedures*/methods , Balloon Occlusion*/methods , Reperfusion*/methods , Cerebral Revascularization*/methods , Embolic Protection Devices*, Humans ; Aged ; Male ; Female ; Stents ; Middle Aged
Entry Date(s):
Date Created: 20250624 Date Completed: 20250908 Latest Revision: 20250909
Update Code:
20250910
DOI:
10.1016/j.jocn.2025.111413
PMID:
40555005
Database:
MEDLINE

Further Information

Background: Carotid artery stenosis is a common cause of stroke. Carotid artery stenting (CAS) includes multiple approaches to endovascular carotid revascularization, including transfemoral/transradial CAS (TF-CAS/TR-CAS) and transcarotid artery revascularization (TCAR). Although CAS has declined in frequency since the development of TCAR, distal embolic protection (DEP) strategies differ between the two procedures, with studies reporting a lower risk of stroke with TCAR. TCAR uses open surgical common carotid artery clamping combined with passive flow reversal (PFR), whereas traditional TF-CAS/TR-CAS often employs a DEP device. Modifications to TF-CAS/TR-CAS include balloon guide catheter (BGC) carotid occlusion and PFR for additional DEP, mirroring aspects of TCAR.
Methods: Patients underwent endovascular carotid artery revascularization (ECAR) using either transfemoral or transradial approaches (i.e., TF-CAS/TR-CAS) with the implementation of multiple DEP strategies: proximal flow arrest with a BGC, active flow reversal (AFR) and PFR, DEP device, and balloon-assisted reperfusion (BAR).
Results: Two patients underwent successful TF-CAS/TR-CAS utilizing a DEP device in combination with novel adjuvant endovascular techniques. BGC occlusion of the common carotid artery provided anterograde flow arrest. AFR was employed during scenarios where PFR was not feasible or insufficient. BAR was performed with transient balloon occlusion of the proximal internal carotid artery during common carotid artery reperfusion and restoration of anterograde blood flow.
Conclusion: Adjuvant endovascular techniques can be employed during TF-CAS/TR-CAS that provide similar, if not more, DEP strategies to those used during TCAR. A purely endovascular approach lends itself to a multitude of specialists and eliminates wound care post-procedure, contributing to higher patient satisfaction and fewer complications.
(Published by Elsevier Ltd.)

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.