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Scullen T, Mathkour M, Carr C, Wang A, Amenta PS, Nerva JD, Dumont AS. Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines. J Clin Med 2020; 9:E3460. [PMID: 33121192 PMCID: PMC7693974 DOI: 10.3390/jcm9113460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/15/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
Patient selection for endovascular intervention in extracranial carotid disease is centered on vascular anatomy. We review anatomical considerations for non-traumatic disease and offer guidelines in patient selection and management. We conducted a systematic literature review without meta-analysis for studies involving anatomical considerations in extracranial carotid intervention for non-traumatic disease. Anatomical considerations discussed included aortic arch variants, degree of vessel stenosis, angulation, tortuosity, and anomalous origins, and atheromatous plaque morphology, composition, and location. Available literature suggests that anatomical risks of morbidity are largely secondary to increased procedural times and difficulties in intervention system delivery. We recommend the prioritization of endovascular techniques on an individual basis in cases where accessible systems and surgeon familiarity provide an acceptable likelihood of rapid access and device deployment.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Christopher Carr
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Arthur Wang
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Peter S. Amenta
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - John D. Nerva
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Aaron S. Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
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Kuo MJ, Chen PL, Shih CC, Chen IM. Establishing stable innominate access by inserting a body floss wire from the brachial artery to the femoral artery facilitates right carotid artery stenting in Type III arch anatomy†. Interact Cardiovasc Thorac Surg 2017; 26:8-10. [DOI: 10.1093/icvts/ivx273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/23/2017] [Indexed: 01/10/2023] Open
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Barbiero G, Cognolato D, Casarin A, Stramanà R, Galzignan E, Guarise A. Carotid artery stenting in difficult aortic arch anatomy with or without a new dedicated guiding catheter: preliminary experience. Eur Radiol 2012. [DOI: 10.1007/s00330-012-2708-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Casana R, Tolva V, Majnardi AR, Bianchi PG, Addobati L, Bertoni GB, Cireni LV, Silani V. Endovascular Management of Symptomatic Cerebral Malperfusion Due to Carotid Dissection After Type A Aortic Dissection Repair. Vasc Endovascular Surg 2011; 45:641-5. [DOI: 10.1177/1538574411414301] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Type A acute aortic dissection is a surgical emergency, and supra-aortic trunk involvement may be complicated by stroke in 6% to 20% of cases. A 66-year-old Caucasian female patient underwent a composite repair of the ascending aorta for type A aortic dissection. Postoperative period was complicated by episodes of “drop attack.” Doppler ultrasound of supra-aortic trunks revealed an intimal flap occluding right internal carotid artery. Technique: Multiple stenting was performed from carotid bifurcation to internal carotid artery in order to exclude the dissection intimal flap. After endovascular procedure physiatrist considered that motor functional improvement was better than expected, and we support that endovascular resolution of carotid malperfusion led to a better outcome. Conclusion: According to other experience, endovascular procedure resulted as a safe and effective way. Moreover, ultrasound monitoring of supra-aortic trunks in postoperative period is recommended.
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Affiliation(s)
- R. Casana
- Vascular Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - V. Tolva
- Vascular Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - A. Robecchi Majnardi
- Neurological Rehabilitation Department San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - P. G. Bianchi
- Vascular Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - L. Addobati
- Department of Neurology and Stroke Unit, Istituto Auxologico Italiano IRCCS, University of Milan, Milan, Italy
| | - G. B. Bertoni
- Vascular Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - L. V. Cireni
- Vascular Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - V. Silani
- Department of Neurology and Stroke Unit, Istituto Auxologico Italiano IRCCS, University of Milan, Milan, Italy
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