Usefulness of the minimally invasive flow reversal method in carotid artery stenting: Simplified flow reversal carotid artery revascularization for radial access (SF-CARR)

Abstract

Background

Flow reversal, achieved by occluding both the common and external carotid arteries to induce retrograde flow from the internal carotid artery, is a useful method for preventing distal embolization in cases of carotid artery stenting (CAS). The “conventional method” employed by our institute for CAS involves the use of one-way valves incorporated in a flow reversal system for rapid manual blood aspiration. Subsequently, we recently transitioned from the conventional method to the “simplified flow reversal carotid artery revascularization for radial access (SF-CARR),” in which external carotid artery occlusion is omitted while a transradial approach is implemented. This study aimed to clarify the efficacy and safety of SF-CARR in patients undergoing CAS.

Methods

A retrospective study was conducted in 50 patients diagnosed with internal carotid artery stenosis between 2022 and 2025. Of these, 24 were treated with SF-CARR, while the others underwent the conventional method. We investigated patient characteristics, endovascular procedures, procedural invasiveness, including procedural time, radiation exposure, or contrast agent use, and clinical outcomes.

Results

Compared to the conventional group, a reduced procedural time (p = 0.001) was observed in the SF-CARR group. The radiation exposure dose (p = 0.020), fluoroscopy time (p = 0.003), amount of contrast agent injected (p < 0.001), and number of contrast agent injections (p < 0.001) were also reduced in the SF-CARR group. In addition, the transradial approach was adopted more frequently in the SF-CARR group (p < 0.001), and no significant differences were reported in complications or patients’ outcomes between the two groups.

Conclusion

This novel flow reversal method, “SF-CARR,” can provide minimally invasive treatment to patients with carotid artery stenosis.