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Transcervical Carotid Artery Stenting without Flow Reversal: A Report of Two Cases

Mahmoud Assaad, Abeer Berry, Marcel Zughaib

(Department of Cardiology, Providence and Providence Park Hospitals, Southfield, USA)

Am J Case Rep 2019; 20:15-20

DOI: 10.12659/AJCR.912769


BACKGROUND: The use of a carotid artery stent (CAS) is a management option for high-risk patients with carotid artery stenosis. An access site for CAS that involves the transcervical approach may be performed percutaneously or may require a cutdown, and usually includes a flow-reversal system to reduce the risk of embolization. Two cases are presented where the transcervical approach to CAS incorporated a distal filter for embolic protection, with a successful outcome.
CASE REPORT: 1. A 78-year-old man with a history of prior irradiation for head and neck cancer presented for CAS after clinical evaluation showed that he was a poor candidate for carotid endarterectomy (CEA). A femoral approach for carotid artery access was not successful due to a tortuous type III aortic arch. A surgical cutdown of the carotid artery was performed with the use of a distal filter, and the CAS was inserted with no embolic events. 2. A 69-year-old man with an anatomically high bifurcation of his carotid artery was not a candidate for CEA due to limited carotid artery access. Diagnostic carotid angiography was also difficult to perform. The CAS was successfully sited with the use of a distal filter and with no post-procedural complications.
CONCLUSIONS: CAS is an option for carotid artery stenosis in patients with high surgical risk for CEA. Although a flow-reversal system is usually used to reduce embolic events, these two cases demonstrate that one can also avoid embolism with a distal filter instead.

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