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
  • 39 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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

Keywords

Carotid artery stenting Proximal protection Incomplete flow arrest Superior thyroid artery 

Abbreviations

CAS

Carotid artery stenting

ICA

Internal carotid artery

CCA

Common carotid artery

ECA

External carotid artery

STA

Superior thyroid artery

EPD

Embolic protection device

MRI

Magnetic resonance imaging

T1W

T1 weighted

rSI

Relative signal intensity

LA

Lingual artery

FA

Facial artery

OA

Occipital artery

ROC

Receiver-operating characteristic

Notes

Compliance with ethical standards

Conflict of interest

None.

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.

References

  1. 1.
    Acar M, Salbacak A, Sakarya ME, Zararsiz I, Ulusoy M (2013) The morphometrical analysis of the external carotid artery and its branches with multidetector computerized tomography angiography technique. Int J Morphol 31:1407–1414CrossRefGoogle Scholar
  2. 2.
    Cassese S, Ndrepepa G, King LA, Nerad M, Schunkert H, Kastrati A, Ott I, FUsaro M (2015) Proximal occlusion versus distal filter for cerebral protection during carotid stenting: updated meta-analysis of randomised and observational MRI studies. EuroIntervention 11:238–246CrossRefPubMedGoogle Scholar
  3. 3.
    Cavalcanti DD, Reis CV, Hanel R, Safavi-Abbasi S, Deshmukh P, Spetzler RF, Preul MC (2009) The ascending pharyngeal artery and its relevance for neurosurgical and endovascular procedures. Neurosurgery 65(Suppl):114–120PubMedGoogle Scholar
  4. 4.
    Fazan VP, da Silva JH, Borges CT, Ribeiro RA, Caetano AG, Filho OA (2009) An anatomical study on the lingual–facial trunk. Surg Radiol Anat 31:267–270CrossRefPubMedGoogle Scholar
  5. 5.
    Giugliano G, Stabile E, Biamino G, Petroni G, Sannino A, Brevetti L, Pucciarelli A, Popusoi G, Tesorio T, Cioppa A, Cota L, Salemme L, Sorropago A, Ausania A, Pietra GD, Fontanelli A, Trimarco B, Esposito G, Bubino P (2014) Predictors of carotid occlusion intolerance during proximal protected carotid arterystenting. JACC Cardiovasc Interv 7:1237–1244CrossRefPubMedGoogle Scholar
  6. 6.
    Harada K, Kakumoto K, Morioka J, Saito T, Fukuyama K (2014) Combination of flow reversal and distal filter for cerebral protection during carotid artery stenting. Ann Vasc Surg 28:651–658CrossRefPubMedGoogle Scholar
  7. 7.
    Hayashi N, Hori E, Ohtami Y, Ohtani O, Kuwayama N, Endo S (2005) Surgical anatomy of the cervical carotid artery for carotid endarterecromy. Neuro Med Chir (Tokyo) 45:20–30CrossRefGoogle Scholar
  8. 8.
    Klosek SK, Rungruang T (2008) Topography of carotid bifurcation: considerations for neck examination. Surg Radiol Anat 30:383–387CrossRefPubMedGoogle Scholar
  9. 9.
    Knappich C, Kuehnl A, Tsantilas P, Schmid S, Breitkreuz T, Kallmayer M, Zimmermann A, Eckstein HH (2017) The use of embolic protection devices is associated with a lower stroke and death rate after carotid stenting. JACC Cardiovasc Interv 10:1257–1265CrossRefPubMedGoogle Scholar
  10. 10.
    Lo A, Oehley M, Bartlett A, Adams D, Blyth P, Al-Ali S (2006) Anatomical variations of the common carotid artery bifurcation. ANZ J Surg 76:970–972CrossRefPubMedGoogle Scholar
  11. 11.
    Natsis K, Raikos A, Foundos I, Noussios G, Lazaridis N, Njau SN (2011) Superior thyroid artery origin in Caucasian Greeks: a new classification proposal and review of the literature. Clin Anat 24:699–705CrossRefPubMedGoogle Scholar
  12. 12.
    Omran J, Mahmud E, White CJ, Aronow HD, Drachman DE, Gray W, Abdullah O, Abu-Fadel M, Firwana B, Mishkel G, Al-Dadah AS (2017) Proximal balloon occlusion versus distal filter protection in carotid artery stenting: a meta-analysis and review of the literature. Catheter Cardiovasc Interv 89:923–931CrossRefPubMedGoogle Scholar
  13. 13.
    Ozgur Z, Govsa F, Ozgur T (2008) Assessment of origin characteristics of the front branches of the external carotidartery. J Craniofac Surg 19:1159–1166CrossRefPubMedGoogle Scholar
  14. 14.
    Stabile E, Sannino A, Schiattarella GG, Gargiulo G, Toscano E, Brevetti L, Scudiero F, Gingliano G, Perrino C, Trimarco B, Esposito G (2014) Cerebral embolic lesions detected with diffusion-weighted magnetic resonance imaging following carotid artery stenting: a meta-analysis of 8 studies comparing filter cerebral protection and proximal balloon occlusion. JACC Cardiovasc Interv 7:1177–1183CrossRefPubMedGoogle Scholar

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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