REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2019 September;26(3):115-20

DOI: 10.23736/S1824-4777.19.01423-2

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Current role of transcervical carotid artery stenting with flow reversal

Ralf R. KOLVENBACH ✉

Department of Vascular Surgery and Endovascular Therapy, Catholic Hospital Group Duesseldorf, Augusta Hospital, Duesseldorf, Germany

INTRODUCTION: Transcervical carotid artery stenting with flow reversal (TCAR) was introduced as a minimally invasive alternative to transfemoral stenting (CAS). There is no manipulation without protection in the aortic arch or when crossing the lesion.
EVIDENCE ACQUISITION: The results of several publications as well as two prospective studies and a national registry were analyzed with emphasis on major neurological complications as well as minor lesions documented by diffusion-weighted imaging.
EVIDENCE SYNTHESIS: Morbidity and mortality, as well as major neurological deficits, were significantly less compared to transfemoral carotid artery stenting. In one study, there were significantly fewer lesions in diffusion-weighted imaging compared to CAS with results and outcome similar to open surgery. In contrast to open surgery, the incidence of transient or permanent cranial nerve injury is significantly less.
CONCLUSIONS: TCAR is evolving as a minimally invasive alternative to open surgery in appropriately selected patients with similar low morbidity and mortality but significantly reduced cranial nerve injury.

KEY WORDS: Stents; Carotid arteries; Endovascular procedures