Acta Neurochirurgica

, Volume 160, Issue 6, pp 1121–1127 | Cite as

Predictors of antegrade flow at internal carotid artery during carotid artery stenting with proximal protection

  • Kei Harada
  • Kosuke Kakumoto
  • Shogo Oshikata
  • Kozo Fukuyama
Original Article - Vascular



Carotid artery stenting (CAS) with proximal occlusion effectively prevent distal cerebral embolism by flow arrest at internal carotid artery (ICA); however, the method can expose antegrade flow at ICA due to incomplete flow arrest. The aim of this study was to identify predictors of antegrade flow during CAS with proximal protection.


We retrospectively analyzed clinical and angiographic data among 143 lesions treated with CAS with proximal protection by occluding the common carotid artery (CCA) and external carotid artery (ECA). Flow arrest or antegrade flow at ICA was confirmed by contrast injection during proximal protection.


Antegrade flow at ICA was observed in 12 lesions (8.4%). Compared with lesions in which flow arrest of ICA was achieved, the diameter of the superior thyroid artery (STA) was significantly larger (2.4 ± 0.34 vs. 1.4 ± 0.68 mm, p < 0.001), and the rate of ECA branches other than the STA located 0–10 mm above the bifurcation was significantly higher (50 vs. 8.4%, p < 0.001). Results of multivariate analysis revealed that a diameter of the STA ≥ 2.3 mm (OR 44, 95% CI 8.1–237; p < 0.001) and ECA branches other than the STA located 0–10 mm above the bifurcation (OR 6.0, 95% CI 1.1–32; p = 0.036) were independent predictors of antegrade flow.


Distal filter protection should be combined with proximal protection for the lesions with antegrade flow to prevent distal migration of the carotid debris.


Carotid artery stenting Proximal protection Incomplete flow arrest Superior thyroid artery 



Carotid artery stenting


Internal carotid artery


Common carotid artery


External carotid artery


Superior thyroid artery


Embolic protection device


Magnetic resonance imaging


T1 weighted


Relative signal intensity


Lingual artery


Facial artery


Occipital artery


Receiver-operating characteristic


Compliance with ethical standards

Conflict of interest


Ethical approval

For this type of study, formal consent is not required.

Informed consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryFukuoka Wajiro HispitalFukuokaJapan

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