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Endovascular Stenting of Tandem Carotid Artery Origin and Bifurcation Stenotic Lesions Using Flow Reversal.

Authors
  • Fanous, Andrew A1, 2
  • Yashar, Parham3
  • Sonig, Ashish1, 2
  • Zakeri, Amanda4
  • Snyder, Kenneth V2, 5, 6, 7
  • Levy, Elad I2, 6, 7, 8
  • Davies, Jason M2, 6, 7, 9, 10
  • Siddiqui, Adnan H2, 6, 7, 8, 10
  • 1 Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
  • 2 Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health; Buffalo, NY, USA.
  • 3 KB Surgical Center, Beverly Hills, CA, USA.
  • 4 Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
  • 5 Departments of Neurosurgery and Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
  • 6 Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, State University of New York, Buffalo, NY, USA.
  • 7 Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA.
  • 8 Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
  • 9 Departments of Neurosurgery and Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
  • 10 Jacobs Institute, Buffalo, NY, USA.
Type
Published Article
Journal
Journal of vascular and interventional neurology
Publication Date
Oct 01, 2017
Volume
9
Issue
5
Pages
33–41
Identifiers
PMID: 29163747
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The treatment of tandem lesions involving severe stenosis of the internal carotid artery with concomitant stenosis of the ipsilateral common carotid artery (CCA) origin represents an ongoing challenge. Current options for the treatment of tandem carotid artery origin and bifurcation stenotic lesions include open surgical endarterectomy, endovascular stenting, balloon angioplasty, and hybrid procedures combining both modalities. However, these options are either associated with high peri-operative risks or not always anatomically feasible. We report, for the first time in North America (to the best of our knowledge), an alternative treatment modality that involves obtaining access through a direct carotid cut-down, with serial treatment of the tandem lesions through a combination of retrograde and anterograde endovascular stenting. This technique obviates the need for navigating the aortic arch in patients with difficult arch anatomy and permits the use of distal embolic protection devices, thus decreasing the risk of peri-operative ischemic events.

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