Carotid Stenting by Proximal Protection, Aspiration Flow Reversal and Distal Anchoring using Double Mesh Stent: An Ideal Technique for Unstable Plaques

Background: Carotid artery stenting (CAS) with distal protection/ Endarterectomy are established novel procedures. A modified technique of carotid stenting was found to further minimise the procedural and post procedural embolic events and has superior ease, efficacy and safety profile compared to existing techniques. Method(s): Dedicated plaque characterisation and diffusion imaging of brain was done on the previous day by 3T MRI. Stenting was done under local anesthesia, temporary pacing, radial arterial line and via femoral access as routine. 9 F balloon guide catheter was placed just proximal to the stenosis and connected to the aspiration pump. The forward flow in CCA was arrested by balloon inflation and flow reversal in ICA was achieved by continous aspiration using pump, during each step – Initial wire passage, pre dilatation, negotiation of stent and during deployment. A double mesh stent was used, the distal end of which was positioned distally in landing and slowly deployed. Aspirated material was sent for histopathology study. Diffusion MRI of brain was done the next day. Result(s): There were no neurological events during or post procedure. No incidence of intimal injury which may happen with filter especially in cases of ICA tortuosity. Excellent stent apposition and total absence of plaque intrusion through struts due to additional mesh was worth noting. An OCT can demonstrate this excellently. Not a single diffusion restricting lesion in MRI next day. Conclusion(s): Proximal protection with ICA flow reversal during each step and use of double mesh stent with distal anchoring can potentially nullify embolic events associated with CAS. This technique holds high promise to be the procedure of choice in CAS especially with unstable plaques.

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Artikel online veröffentlicht:
11. Mai 2021