Hybrid Treatment of Extracranial Carotid Artery Disease. (August 2017)

• Record Type: Journal Article
• Authors: Bozzay, Joseph; Broce, Mike; Mousa, Albeir Y.
• Is Part Of: Vascular & endovascular surgery. Volume 51:Number 6(2017)
• Page Start: 373
• Page End: 376
• Publication Date: 2017-08
• Subjects: hybrid -- carotid -- proximal -- concurrent -- stroke -- angioplasty -- endarterectomy; Blood-vessels -- Surgery -- Periodicals; Blood-vessels -- Endoscopic surgery -- Periodicals; Vascular Surgical Procedures -- Periodicals; Angioplasty -- Periodicals; Surgical Procedures, Minimally Invasive -- Periodicals; Vascular Diseases -- surgery -- Periodicals; Vaisseaux sanguins -- Chirurgie -- Périodiques; Vaisseaux sanguins -- Chirurgie endoscopique -- Périodiques; 617.41
• DOI: 10.1177/1538574417710374
• Languages: English
• ISSNs: 1538-5744

Abstract

Objective: High-degree stenosis of both innominate (IA) or left common carotid artery (CCA) and carotid bifurcation is uncommon but still represents a significant challenge to interventionists in many aspects including techniques, timing, and priority. There are several strategies for intervention that have been reported in the literature. A well-described, less-invasive strategy for extracranial tandem carotid lesions is concomitant carotid endarterectomy (CEA) with retrograde carotid angioplasty and stenting (CAS). In this study, we examine intermediate-term outcomes of this hybrid procedure and review other described treatments. Methods: Electronic medical records of all patients who underwent hybrid (ostial CAS and CEA) procedures in a tertiary center over the last 10 years were reviewed. High-degree stenosis of the IA or CCA was defined according to North American Symptomatic Carotid Endarterectomy Trial criteria. Results: A total of 6 patients were identified. The population included 4 males and 2 females with a median age of 65 years. Five patients were symptomatic and all had stenosis >75% by angiography. Five of the patients underwent left CEA with proximal stenting and one patient underwent right-sided CEA with proximal stenting. Combined 30-day mortality and stroke rate was 0%. No restenosis, stroke, heart attack, or death occurred during a follow-up range of 1 to 36 months (mean 12.8 months, median 7.8 months). Conclusion: The combined CEA with retrograde stenting for tandem extracranial lesion procedure is safe and feasible, with adequate intermediate-term outcomes consistent with the recent literature.