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Carotid artery stenting with proximal embolic protection via the transbrachial approach: sheathless navigation of a 9-F balloon-guiding catheter

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Neurology, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka City, Fukuoka, 810-0001, Japan

    Junpei Koge, Tetsuya Hashimoto, Shigehisa Mizuta, Eri Tanaka, Masakazu Kawajiri & Takeshi Yamada

  2. Department of Vascular Neurology, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan

    Junpei Koge, Tomonori Iwata & Tetsuya Hashimoto

  3. Department of Neurosurgery, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan

    Yukihiko Nakamura

  4. Department of Radiology, Saiseikai Fukuoka General Hospital, Fukuoka City, Fukuoka, Japan

    Shun-ichi Matsumoto

Authors
  1. Junpei Koge
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  2. Tomonori Iwata
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  3. Tetsuya Hashimoto
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  4. Shigehisa Mizuta
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  5. Yukihiko Nakamura
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  6. Eri Tanaka
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  7. Masakazu Kawajiri
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  8. Shun-ichi Matsumoto
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  9. Takeshi Yamada
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Corresponding author

Correspondence to Junpei Koge.

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No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

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Informed consent was obtained from all individual participants included in the study.

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Koge, J., Iwata, T., Hashimoto, T. et al. Carotid artery stenting with proximal embolic protection via the transbrachial approach: sheathless navigation of a 9-F balloon-guiding catheter. Neuroradiology 60, 1097–1101 (2018). https://doi.org/10.1007/s00234-018-2085-2

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  • DOI: https://doi.org/10.1007/s00234-018-2085-2

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