Carotid Stenting with Distal-Balloon Protection via the Transbrachial Approach

Abstract

Purpose:

To document the feasibility of brachial artery access for carotid stenting with distal-balloon protection of the internal carotid artery (ICA).

Technique:

Via percutaneous access to the brachial artery, a large double-curve catheter is advanced into the aortic arch over a hydrophilic guidewire to cannulate the left common carotid artery. Following sheath exchange, a GuardWire distal-protection balloon is positioned within the left ICA distal to the stenosis. The lesion is dilated, followed by deployment and dilation of a self-expanding stent. Transcranial Doppler monitoring shows only scarce microembolic signals during the procedure.

Conclusions:

Carotid stenting with distal balloon protection via the brachial artery appears feasible as an alternative to standard femoral access.

Keywords

vascular access cerebral protection devices embolization internal carotid artery balloon occlusion

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References

Henry

Amor

Henry

. Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system. J Endovasc Surg. 1999;6:321–331.

Henry

Klonaris

. Benefits of cerebral protection with the PercuSurge GuardWire system during carotid stenting: midterm results. J Endovasc Ther. 2001: in press.

Castriota

Cremonesi

Manetti

. Carotid stenting using radial artery access [letter]. J Endovasc Surg. 1999;6:385–386.

Yoon

Shim

. Transseptal approach for stent implantation in right internal carotid artery stenosis. J Invasive Cardiol. 2000;12:70–74.

Joseph

Krishnaswami

Baruah

. Transseptal approach to aortography and carotid artery stenting in pulseless disease. Cathet Cardiovasc Diagn. 1997;40:416–420.

Sievert

Ensslen

Fach

. Brachial artery approach for transluminal angioplasty of the internal carotid artery. Cathet Cardiovasc Diagn. 1996;39:421–423.

Ohki

Marin

Lyon

. Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential. J Vasc Surg. 1998;27:463–471.

Théron

Payelle

Coskun

. Carotid artery stenosis: treatment with protected balloon angioplasty and stent placement. Radiology. 1996;201:627–636.

Ohki

Veith

. Carotid stenting with and without protection devices: should protection be used in all patients? Semin Vasc Surg. 2000;13:144–152.

10.

Parodi

La Mura

Ferreira

. Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vasc Surg. 2000;32:1127–1136.

11.

Martin

Pache

Treggiari-Venzi

. Role of the distal balloon protection technique in the prevention of cerebral embolic events during carotid stent placement. Stroke. 2001;32:479–484.

12.

Al-Mubarak

Vitek

Iyer

. Embolization via collateral circulation during carotid stenting with the distal balloon protection system. J Endovasc Ther. 2001;8:354–357.