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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2005 June;46(3):229-39

language: English

Advantages and indications of transcervical carotid artery stenting with carotid flow reversal

Lo C. H. 1, Doblas M. 2, Criado E. 1

1 Division of Vascular Surgery Stony Brook University Hospital, Stony Brook New York, USA
2 Division of Vascular Surgery Complejo Hospitalario de Toledo, Toledo, Spain


Carotid angioplasty and stenting (CAS) has become an increasingly popular alternative to traditional carotid endarterectomy for treatment of extracranial carotid artery disease. Several prospective randomized trials have demonstrated the safety and efficacy of CAS to be comparable to surgery. Wider acceptance of this new technique, however, has been hampered by concerns of neurologic injury resulting from cerebral embolization, a potential complication of catheter based carotid interventions. Several different types of cerebral protection devices (CPDs) have been developed to minimize this complication. Particle debris analysis and imaging data utilizing transcranial Doppler and MRI scanning have shown that cerebral embolization is a ubiquitous problem in CAS that is not entirely eliminated even with cerebral protection. One of the more effective methods of achieving cerebral protection during CAS involve reversing flow in the internal carotid artery, preventing embolic debris from reaching the cerebral circulation. Additional obstacles to carotid stenting include anatomic limitations that prevent safe access to the aortic arch and carotid vessels. The technique of transcervical carotid stenting combines the cerebral protective features of flow reversal with the ability to access the supra-aortic branches through a limited surgical cutdown, eliminating the need for transfemoral access in patients with aortoiliac disease or unfavorable arch anatomy. The procedure is well tolerated under local anesthesia and avoids the extra expense and training required to use a dedicated CPD. The clinical outcome for transcervical carotid stenting has been very favorable with a low complication rate and complete freedom from stroke or death in the immediate postoperative period. Long-term follow-up data on patients undergoing this procedure have demonstrated a near perfect patency rate with no restenosis. In this article, we describe in detail the advantages of and indications for transcervical carotid stenting with flow reversal.

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