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Cifuentes S, Cirillo-Penn NC, Breite MD, Rasmussen TE. Hybrid repair of tandem high-grade innominate and carotid artery stenosis in an asymptomatic male. J Vasc Surg Cases Innov Tech 2024; 10:101487. [PMID: 38666003 PMCID: PMC11043857 DOI: 10.1016/j.jvscit.2024.101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/07/2024] [Indexed: 04/28/2024] Open
Abstract
Tandem atherosclerotic lesions of the innominate artery (IA) and internal carotid artery (ICA) are challenging and represent an inherent risk of cerebrovascular accident. Treating asymptomatic patients is controversial; therefore, it is critical to minimize the risk of a cerebrovascular accident if repair is undertaken. An asymptomatic 78-year-old man with a chronically occluded left ICA and tandem stenoses of the IA and right ICA underwent a hybrid intervention with stenting of the IA lesion and right ICA endarterectomy. The intra- and postoperative course was successful, without any signs of neurological sequelae. Sixteen months later, the patient remained asymptomatic, with patent reconstructions.
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Affiliation(s)
| | | | - Matthew D. Breite
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Todd E. Rasmussen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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Cheng P, Liu B, Yu D, Xu J. The value of color Doppler sonography in diagnosis and hemodynamic analysis of innominate artery occlusion. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:351-353. [PMID: 35044709 DOI: 10.1002/jcu.23139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/12/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
The occlusion of the innominate artery caused a significant decrease in the distal end of the right subclavian artery and the right common carotid artery, internal carotid artery, and external carotid artery (ECA). Due to the different pressure and the abundant communicating arteries between the ECA and the bilateral vertebral artery (VA), different paths of blood steal in the anterior and posterior circulation occurred.
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Affiliation(s)
- Pan Cheng
- Department of Ultrasonography, Tianjin Huanhu Hospital, Tianjin Neurosurgical Institute, Tianjin, China
| | - Baolong Liu
- Department of Ultrasonography, Tianjin Huanhu Hospital, Tianjin Neurosurgical Institute, Tianjin, China
| | - Delin Yu
- Department of Ultrasonography, Tianjin Huanhu Hospital, Tianjin Neurosurgical Institute, Tianjin, China
| | - Jing Xu
- Department of Ultrasonography, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, Tianjin, China
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Transcervical carotid artery revascularization: A systematic review and meta-analysis of outcomes. J Vasc Surg 2021; 74:657-665.e12. [PMID: 33864829 DOI: 10.1016/j.jvs.2021.03.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/14/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Carotid artery stenosis is considered a determinant factor for cerebrovascular events, estimated to be the cause of 10% to 20% of all ischemic strokes. Transcervical carotid artery revascularization (TCAR) has been offered as an alternative to transfemoral carotid artery stenting and carotid endarterectomy to treat carotid artery stenosis. METHODS We performed a systematic review and meta-analysis of prospective and retrospective studies reporting the outcomes of patients who had undergone TCAR for carotid artery stenosis. The incidence of periprocedural adverse events was calculated. RESULTS A total of 45 studies with 14,588 patients met the predefined eligibility criteria and were included in the present meta-analysis. The technical success rate was 99% (95% confidence interval [CI], 98%-99%). The reasons for technical failure included an inability to cross the lesion and/or failure to deploy the stent. Access site complications occurred in 2% of all cases (95% CI, 1%-2%; 30 studies). Overall, the incidence of cranial nerve (CN) injuries was very rare, with only 33 of 8994 patients experiencing neurologic deficits attributed to CN involvement. Bleeding complications were reported by 20 studies and occurred in 2% (95% CI, 1%-3%) of all cases. The overall periprocedural all-cause mortality and stroke rate was 0.5% and 1.3%, respectively. In-stent restenosis was observed in 4 of 260 patients (1.5%; 7 studies), and early (30-day) reocclusion or acute thrombosis of the target lesion occurred in 12 of 1243 patients (∼1%; 11 studies). CONCLUSIONS The results from the present study have provided significant evidence that TCAR is a very promising and safe carotid revascularization approach with favorable technical success rates associated with low periprocedural stroke and CN injury rates.
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Zarmakoupis C, Galyfos G, Tsoukalos G, Dalla P, Triantafyllou A, Zografos K, Sigala F, Filis K. Hybrid Repair of a Common Carotid Pseudoaneurysm and Concomitant Internal Carotid Stenosis With Retrograde Stenting and Carotid Endarterectomy. Vasc Endovascular Surg 2021; 55:627-630. [PMID: 33691546 DOI: 10.1177/1538574421992935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report aims to present a rare case of a common carotid artery (CCA) pseudoaneurysm with a concomitant internal carotid artery (ICA) stenosis that were treated with a hybrid technique. This strategy included the retrograde placement of a CCA covered stent under ICA clamping followed by standardized carotid endarterectomy. The technique will be discussed and compared with other possible treatments.
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Affiliation(s)
- Constantinos Zarmakoupis
- Vascular and Endovascular Surgery Department, Athens Euroclinic, Athens, Greece.,First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - George Galyfos
- Vascular and Endovascular Surgery Department, Athens Euroclinic, Athens, Greece.,First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Grigorios Tsoukalos
- Vascular and Endovascular Surgery Department, Athens Euroclinic, Athens, Greece
| | - Panagiota Dalla
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Alexandra Triantafyllou
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Zografos
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Fragiska Sigala
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
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Wang MT, Schembri M, Kok HK, Maingard J, Foo M, Lamanna A, Brooks M, Asadi H. Rendezvous endovascular common carotid artery stenting (RECCAS) technique for symptomatic steno-occlusive disease. CVIR Endovasc 2021; 4:17. [PMID: 33459863 PMCID: PMC7813902 DOI: 10.1186/s42155-020-00194-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
This report describes a patient who presented with acute but transient right arm weakness and altered sensation secondary to severe stenosis of the left common carotid artery (CCA) origin. Endovascular stenting of the stenosed origin was achieved utilising a novel rendezvous technique through combined retrograde common carotid artery and anterograde transfemoral approaches. This technique has numerous potential advantages over traditional transfemoral endovascular and open retrograde common carotid artery approaches. It allows increased procedural control and success in traversing the stenosis and provides a smooth transition for the stent delivery catheter. An open cutdown procedure or open surgical technique is not required. Our patient recovered well from the procedure with no complications within the three-month follow up period.
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Affiliation(s)
- M T Wang
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.
| | - M Schembri
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service, Department of Radiology, Northern Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia
| | - J Maingard
- School of Medicine, Deakin University, Melbourne, Australia.,Interventional Radiology and Neurointerventional Services, Department of Radiology, Monash Health, Melbourne, Australia
| | - M Foo
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - A Lamanna
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - M Brooks
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia
| | - H Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia.,Interventional Radiology and Neurointerventional Services, Department of Radiology, Monash Health, Melbourne, Australia
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Robertson V, Poli F, Saratzis A, Divall P, Naylor AR. A Systematic Review of Procedural Outcomes in Patients With Proximal Common Carotid or Innominate Artery Disease With or Without Tandem Ipsilateral Internal Carotid Artery Disease. Eur J Vasc Endovasc Surg 2020; 60:817-827. [DOI: 10.1016/j.ejvs.2020.06.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/07/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
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Zacharias N, Goodney PP, DeSimone JP, Stone DH, Wanken ZJ, Suckow BD, Columbo JA, Powell RJ. Outcomes of Innominate Artery Revascularization Through Endovascular, Hybrid, or Open Approach. Ann Vasc Surg 2020; 69:190-196. [PMID: 32554196 DOI: 10.1016/j.avsg.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atherosclerotic disease of the innominate artery (IA) is rare and can lead to cerebral, upper extremity, and vertebral steal symptoms. Nonocclusive lesions can be treated with endovascular interventions, often with a hybrid approach while performing a right carotid endarterectomy (RCEA). Calcified IA lesions have a high risk of embolization to bilateral cerebral hemispheres. Occlusive lesions may require treatment through a median sternotomy and bypass. The purpose of our study is to review our short-term and long-term outcomes of IA revascularization. METHODS Our operative database was used to identify patients who underwent IA revascularization between January 1998 and December 2018. Patients who underwent innominate artery stenting (IAS), combined with RCEA and IAS as well as aortoinnominate bypass (AIB), were identified. Our primary end points were freedom from neurologic event, all-cause mortality, and need for reintervention. RESULTS Thirty-three patients (18 females [55%]) who underwent IA revascularization were identified. Average age was 67 ± 8 years, and mean clinical follow-up was 51 ± 21 months. Most patients (30 [91%]) were on a statin and antiplatelet therapy. Twenty-one patients (64%) were symptomatic. Twelve patients (36%) were asymptomatic and underwent combined RCEA with retrograde IAS for critical right carotid stenosis and IA stenosis. Preoperative imaging included a carotid duplex and computed tomography angiography. Eighteen patients (55%) underwent RCEA + IAS, 11 patients (33%) underwent isolated IAS, and 4 patients (12%) underwent AIB. In our attempt to protect bilateral hemispheres during IAS for heavily calcified lesions, we used right common carotid artery (CCA) clamping although open exposure and left CCA embolic protection filter was placed through transfemoral approach. Patients who underwent AIB had chronic heavily calcified IA occlusions or occluded IA stents with failed endovascular interventions. Perioperative stroke rate was 3%, involving 1 patient who developed reperfusion syndrome after RCEA + IAS. Perioperative mortality was 0%. Long-term stroke rate was 0%, and long-term mortality was 15% (5 of 33) because of cardiac disease. Overall restenosis rate was 9%, involving 3 patients who required secondary interventions for IA in-stent restenosis. CONCLUSIONS IA interventions through a hybrid approach or an open approach are safe, with acceptable perioperative stroke and mortality rates. Long-term patency of these interventions is acceptable. Bilateral cerebral embolic protection can be accomplished by clamping the right CCA through an open exposure and placing a filter in the left CCA through a transfemoral approach. Patients undergoing IAS appear to have a higher rate of restenosis compared with AIB, and therefore, close follow-up with noninvasive imaging is recommended.
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Affiliation(s)
- Nikolaos Zacharias
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Philip P Goodney
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Joseph P DeSimone
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David H Stone
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Zachary J Wanken
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern D Suckow
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jesse A Columbo
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Richard J Powell
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Endovascular stenting of supra-aortic lesions using a transcarotid retrograde approach and flow reversal: A multicenter case series. J Vasc Surg 2020; 71:2012-2020.e18. [DOI: 10.1016/j.jvs.2019.08.269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023]
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Yamauchi K, Kumagai M, Itazu T, Sakai H. Open Retrograde Stenting with a Sheathless Method Using a Balloon-guiding Catheter for Proximal Common Carotid Artery Stenosis. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:331-335. [PMID: 37502172 PMCID: PMC10370596 DOI: 10.5797/jnet.tn.2020-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/20/2020] [Indexed: 07/29/2023]
Abstract
Objective Carotid artery stenting (CAS) and carotid endarterectomy are relatively difficult for proximal common carotid artery (CCA) stenosis because of the difficulty in anatomical approach. We treated proximal CCA stenosis by retrograde stenting using a 9Fr Optimo for peripheral intervention with a sheathless method. Case Presentation A 60-year-old woman was scheduled for total arch replacement (TAR) for an aortic arch aneurysm. Preoperative cervical MRI incidentally revealed tandem stenosis in the left CCA. We intended to treat CCA stenosis prior to aortic arch replacement. Under general anesthesia, distal left CCA was exposed. A 9Fr Optimo was introduced into CCA by retrograde with a sheathless method. The retrograde CAS was performed under distal balloon protection. Her postoperative course was uneventful. Conclusion Retrograde stenting using a 9Fr Optimo for peripheral intervention with a sheathless method was safe and useful for proximal CCA stenosis.
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Affiliation(s)
- Keita Yamauchi
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Masaki Kumagai
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Takaaki Itazu
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Hideki Sakai
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
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Yamao Y, Ishii A, Satow T, Iihara K, Sakai N. The Current Status of Endovascular Treatment for Extracranial Steno-occlusive Diseases in Japan: Analysis Using the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). Neurol Med Chir (Tokyo) 2020; 60:1-9. [PMID: 31748443 PMCID: PMC6970071 DOI: 10.2176/nmc.st.2018-0315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Endovascular treatment of extracranial steno-occlusive lesions is an alternative to direct surgery. There is no consensus regarding the natural course and standard treatment of these lesions. The aim of this study was to identify the current status of endovascular treatment for extracranial steno-occlusive lesions. A total of 1154 procedures for extracranial steno-occlusive lesions, except for internal carotid artery stenosis, were collected from the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). Atherosclerotic lesions were most frequent (1021 patients, 88.5%). Endovascular treatment was performed for 456 (39.5%) patients with subclavian artery, 349 (30.2%) with extracranial vertebral artery, 172 (14.9%) with the origin of common carotid artery, and 38 (3.3%) with innominate artery stenosis; the overall technical success rate was 98.0%. Percutaneous transluminal angioplasty was performed in 307 patients (26.6%) and stenting in 838 (72.6%). An embolic protection device (EPD) was used in 571 patients (49.5%), and procedure under general anesthesia was performed in 168 (14.6%). Preoperative antiplatelet therapy was administered in 1091 procedures (94.5%). A good outcome was obtained for 962 patients (83.4%). Complications were observed in 89 patients (7.7%). The procedure under general anesthesia was statistically significant factors (P <0.01), and also after multivariable adjustment (odds ratio 2.29; 95% confidence interval 1.25–4.17; P <0.01). Comparisons between JR-NET3 and previous cohorts (JR-NET1&2), the utilization of EPD and complications increased significantly, and the type of antiplatelet therapy changed markedly. Based on the results of this study, endovascular treatment for extracranial steno-occlusive lesions is relatively safe. Further prospective studies are necessary to validate the beneficial effects.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Tetsu Satow
- Department of Neurosurgery, National cerebral and Cardiovascular Center
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Nobuyuki Sakai
- Department of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation.,Department of Neurosurgery, Kobe City Medical Center General Hospital
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Del Valle CE, Ferreira LFT, Bragato PH, Oliveira SLD, Mauro FDO, Araújo WJBD. Inversão total do fluxo em artéria carótida interna direita em paciente com estenose grave do tronco braquiocefálico. J Vasc Bras 2020; 19:e20190124. [PMID: 34178067 PMCID: PMC8202210 DOI: 10.1590/1677-5449.190124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Occlusions and severe stenoses of the innominate artery (brachiocephalic trunk) are
rare and present with a wide variety of clinical manifestations, with hemispheric,
vertebrobasilar and right upper limb ischemic symptoms. The most common cause is
atherosclerosis. Duplex scanning may show right vertebral artery flow reversal,
diminished subclavian flow, and several patterns of right carotid flow disturbance,
including slow flow, partial flow reversal during the cardiac cycle and even complete
reversal of flow in the internal carotid artery, which is a very uncommon finding.
Herein, the authors describe the case of a female patient who was a heavy smoker, had
severe stenosis of the brachiocephalic trunk, and had episodes of collapse. Besides
the subclavian steal and partial flow reversal in the common carotid artery, duplex
scanning also showed high-velocity reversed flow in the internal carotid artery
during the entire cardiac cycle, a finding that is not reported in the literature at
this magnitude.
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Beteck B, Corn R, Grimsley BR. Effectiveness of treatment of innominate artery stenosis with retrograde supra-aortic stent using a flow reversal stent system. Proc (Bayl Univ Med Cent) 2018; 31:493-495. [PMID: 30948990 DOI: 10.1080/08998280.2018.1483154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022] Open
Abstract
We present the case of a 71-year-old man with critical stenosis of the innominate artery after previously undergoing bilateral carotid artery endarterectomies. We used an open retrograde approach of the right carotid artery to stent the innominate artery lesion employing the new ENROUTE Transcarotid Stent System with flow reversal.
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Affiliation(s)
- Besem Beteck
- Division of Vascular Surgery, Baylor University Medical CenterDallasTexas
| | - Robert Corn
- Division of Vascular Surgery, Baylor University Medical CenterDallasTexas
| | - Bradley R Grimsley
- Division of Vascular Surgery, Baylor University Medical CenterDallasTexas
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