Carotid artery stenting with proximal embolic protection via the transbrachial approach: sheathless navigation of a 9-F balloon-guiding catheter
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Transbrachial carotid artery stenting (TB-CAS) is performed as an alternative procedure for patients with hostile vascular anatomy of the aortic arch and aortic or peripheral artery disease. Proximal protection during TB-CAS is not generally feasible because a small size of the brachial artery may preclude using a large-diameter sheath introducer. We, herein present a novel method that enables proximal protection during TB-CAS by sheathless navigation of a 9-F balloon-guiding catheter equivalent to a 7-F sheath.
We analyzed eight consecutive patients who underwent TB-CAS with proximal protection using the sheathless method from April 2016 to June 2017. Relevant demographic, radiographic, and procedural features were retrospectively reviewed.
We performed TB-CAS using our method for five patients with a bovine or type 3 aortic arch, for one patient with combined peripheral artery disease, and for two patients with a type 1 or 2 aortic arch. We successfully navigated the balloon-guiding catheter via the brachial artery and performed CAS under proximal flow control in all patients. However, we experienced kinking and exchange of the balloon-guiding catheter in one patient and a periprocedural thromboembolic event occurred. A pseudoaneurysm at the access site developed in one patient.
TB-CAS with proximal embolic protection using the sheathless method is feasible and may provide an alternative approach in carefully selected patients who have difficult anatomy in the transfemoral approach and plaques with a high risk of distal embolization.
KeywordsCarotid artery disease Carotid artery stenting Transbrachial approach Embolic protection
Compliance with ethical standards
No funding was received for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K (2004) Stenting and angioplasty with protection in patients at high risk for endarterectomy investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501CrossRefPubMedGoogle Scholar
- 3.Montorsi P, Galli S, Ravagnani PM, Trabattoni D, Fabbiocchi F, Lualdi A, Ballerini G, Andreini D, Pontone G, Caputi L, Bartorelli AL (2014) Carotid artery stenting in patients with left ICA stenosis and bovine aortic arch: a single-center experience in 60 consecutive patients treated via the right radial or brachial approach. J Endovasc Ther 21:127–136CrossRefPubMedGoogle Scholar
- 4.Montorsi P, Galli S, Ravagnani P, Ghulam Ali S, Trabattoni D, Fabbiocchi F, Lualdi A, Ballerini G, Andreini D, Pontone G, Annoni A, Bartorelli AL (2009) Carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration. Eur Radiol 19:2009–2015CrossRefPubMedGoogle Scholar
- 7.Montorsi P, Caputi L, Galli S, Ciceri E, Ballerini G, Agrifoglio M, Ravagnani P, Trabattoni D, Pontone G, Fabbiocchi F, Loaldi A, Parati E, Andreini D, Veglia F, Bartorelli AL (2011) Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 58:1656–1663CrossRefPubMedGoogle Scholar
- 8.Montorsi P, Galli S, Ravagnani PM, Tresoldi S, Teruzzi G, Caputi L, Trabattoni D, Fabbiocchi F, Calligaris G, Grancini L, Lualdi A, de Martini S, Bartorelli AL (2016) Carotid artery stenting with proximal embolic protection via a transradial or transbrachial approach: pushing the boundaries of the technique while maintaining safety and efficacy. J Endovasc Ther 23:549–560CrossRefPubMedGoogle Scholar