The Use of Intravascular Ultrasonography in Transcarotid Artery Revascularization Optimizes Stent Placement
Transcarotid artery revascularization (TCAR) has been shown to have increasingly promising outcomes compared with transfemoral carotid artery stenting and carotid artery endarterectomy. At present, the standard practice is to obtain two two-dimensional angiographic views separated by 90 ° to evaluate stent deployment. Suboptimal stent deployment, poor stent apposition, or residual vessel stenosis are potential factors that can poorly affect the outcome. Postdilatation angioplasty can often correct these issues; however, it can be associated with a greater risk of embolic events.
ConclusionThis case is the first report of an ECA to internal carotid artery transposition as an option in the management of ECA stenosis in preparation for an STA-MCA bypass for the purpose of flow augmentation.
Conclusions: Individuals without a previous contralateral endarterectomy and/or history of diabetes are at lower risk of hemodynamic instability. The addition of computed tomography angiographic variables does not improve this prediction. Future prospective, randomized work is required to improve our ability to identify and treat individuals at high risk of instability during carotid angioplasty and stenting.
CONCLUSIONS: This study demonstrates successful use of an augmented reality tele-proctoring platform to guide a neuro-endovascular fellow through complex neuro-interventional procedures from a remote setting.PMID:34346826 | DOI:10.1177/15910199211035304
CONCLUSION: Long-term hemodynamic adaptations post-pipeline embolization device demonstrate decreased wall shear stress and decreased mean and diastolic flow velocities in the distal middle cerebral artery, which suggest decreasing velocity of blood flow with endothelialization of the device. Furthermore, follow-up NOVA is a useful tool for detecting potential flow-related complications such as in-stent stenosis.PMID:34346801 | DOI:10.1177/15910199211034668
ConclusionsTRA is a safe and feasible approach for flow diversion using the Surpass Evolve device. Rates of access site complications is favorable. Overall rate of conversion to TFA is low. Our early experience suggests frontline TRA is feasible for the utilization of Surpass Evolve flow diverting device.Disclosures Z. Hubbard: None. B. Saway: None. K. Zilinskas: None. G. Porto: None. S. Al Kasab: None. M. Sattur: None. A. Spiotta: None.
ConclusionThe novel technique to revascularize tandem occlusion utilizing a stent-retriever as a distal protection device along with an aspiration catheter and a balloon-guided catheter is feasible. Immediate flow restoration at the distal occlusion site with simultaneous revascularization of the proximal ICA steno-occlusive lesion potentially improves the puncture to reperfusion timeDisclosures S. Suzuki: None. J. Granstein: None. A. Chan: None. B. Ball: None. V. Vu: None. K. Golshani: None. I. Yuki: None.
ConclusionDeploying self-expanding stents through an angioplasty balloon catheter is feasible, safe, and can greatly simplify the procedure. The Neuroform Atlas stent is strong enough to prevent immediate recoil of intracranial stenosis after angioplasty.Disclosures A. Takayanagi: None. J. Fields: None. K. Chao: None. D. Rex: None. P. Cheng: None. L. Feng: None.
ConclusionsEndovascular treatment, including PTA (with or without stenting) and CCB infusion, may be effective in medically-refractory GCA with intracranial arterial stenosis but complication rates are considerable. The efficacy of CCB monotherapy implicates vascular smooth muscle dysfunction in the pathogenesis of intracranial GCA.Calcium-channel blocker infusion as monotherapy for intracranial giant cell arteritis. Pre-treatment angiography (lateral right internal carotid artery projection) shows severe focal supraclinoid ICA stenosis (curved white arrow, 1A). Post-verapamil infusion (20mg, 15 min delay) angiogram (1B) s...
ConclusionIn the experience of this single-center, the use of the transradial approach for neuroendovascular procedures seems to result in a relatively low rate of access complications and shifting access technique. Our results, while limited in the size of sample, contribute to the growing body of literature that sheds insight on the benefit of transradial access.Disclosures M. Taqi: None.
Tandem carotid artery stenoses, one at the carotid bifurcation and one more proximal in the common carotid artery or innominate artery, are rare. I suspect that their incidence may increase with the ubiquitous availability of computed tomography angiography. Treatment of these lesions with a hybrid approach with stent placement or angioplasty of the proximal lesion and open endarterectomy of the carotid bifurcation was first reported in 1996.1 A prior meta-analysis showed excellent results.2 More recent reports have urged caution because the stroke and death rate were almost reaching unacceptable levels.