Carotid artery stenting for patients with occipital–vertebral anastomosis. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Kajikawa, Ryuichiro; Fujinaka, Toshiyuki; Nakamura, Hajime; Kinoshita, Manabu; Nishida, Takeo; Kishima, Haruhiko
• Is Part Of: Interventional neuroradiology. Volume 25:Issue 2(2019:Apr.)
• Page Start: 212
• Page End: 218
• Publication Date: 2019-04
• Subjects: Occipital vertebral anastomosis -- carotid artery stenting -- embolic protection technique; Nervous system -- Interventional radiology -- Periodicals; Nervous system -- Radiography -- Periodicals; Nervous System Diseases -- Periodicals -- radiography; Neuroradiography -- Periodicals; Radiography, Interventional -- Periodicals; Nervous system -- Radiography; Periodicals; 617.4805
• DOI: 10.1177/1591019918802924
• Languages: English
• ISSNs: 1591-0199

Abstract

Background and purpose: We report the outcomes of carotid artery stenting for patients with angiographically visible occipital artery–vertebral artery anastomosis. Methods: Among 47 consecutive patients who underwent carotid artery stenting from January 2007 to December 2010, seven patients for whom cerebral angiograms clearly showed occipital artery–vertebral artery anastomosis were selected. Four different protection methods were used: distal internal carotid artery protection; carotid flow reversal; seatbelt and airbag technique; and double protection method of protecting both the external and internal carotid artery. Results: One patient with distal internal carotid artery protection showed a high-intensity lesion at the border of the upper thalamus, internal capsule and lateral ventricle wall after carotid artery stenting. The other patient with the double protection method did not show any high-intensity lesions on postoperative diffusion-weighted imaging in the vertebrobasilar territory. All seven patients with visible occipital artery–vertebral artery anastomosis showed ipsilateral vertebral artery severe stenosis or occlusion. Conclusion: Large occipital artery–vertebral artery anastomosis may be a pathway for embolic materials during carotid artery stenting. External carotid artery protection is recommended for carotid artery stenting in such patients.