E-163 Transfemoral flow reversal through balloon guide catheter for carotid artery stenting: proof of concept using a robotic transcranial doppler. (23rd July 2022)

• Record Type: Journal Article
• Authors: Cappuzzo, J; Monteiro, A; Waqas, M; Almayman, F; Snyder, K; Levy, E; Siddiqui, A
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A164
• Page End: A165
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.274
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: Flow-reversal through transfemoral balloon-guide catheter (BGC) for carotid artery stenting (CAS) was described among the first embolic protection methods. However, the technique was never adopted due to lack of proof about flow-reversal and emboli count, and technical difficulties associated with older BGCs, such as stiffness and incompatibility with other catheters. We demonstrate flow-reversal through a Walrus BGC for transfemoral CAS, using a robotic transcranial doppler (rTCD) with the purpose of proof of concept. Methods: A patient undergoing transfemoral CAS with flow-reversal through a Walrus BGC was monitored with a rTCD device (Figure 1). Results: Red color at the depth of the ICA terminus indicates forward flow (Figure 1). Prior to crossing the plaque for placement of a distal filter and/or angioplasty, we inflate the BGC and open the three-way stopcock, allowing back bleed. At this moment, the rTCD shows a change in blood flow direction, indicated as change from red to blue (Figure 1), which likely occurs due to a passive pressure gradient between the intracranial compartment and the atmospheric pressure. Then, the filter is placed with reduced risk of displacing plaque fragments, and angioplasty and stenting are performed with dual-layer of protection. Conclusions: This technique may confer greater safety CAS with flow-arrest or without proximal protection. Though in this case rTCD was used for proof of concept, it can be also employed as a embolic monitoring tool during carotid artery procedures. Disclosures: J. Cappuzzo: None. A. Monteiro: None. M. Waqas: None. F. Almayman: None. K. Snyder: None. E. Levy: None. A. Siddiqui: None.