Purpose: To assess the safety and efficacy of carotid artery stenting (CAS) of the left internal carotid artery (LICA) from a right radial/brachial approach in patients with bovine aortic arch. Methods: Among 505 consecutive CAS patients treated at our facility between June 2007 and December 2012, 60 (11.9%) patients (44 men; mean age 73±9 years) with LICA stenosis and bovine arch were treated from a right radial (n=32) or brachial (n=28) approach. Three quarters of the patients had characteristics qualifying them at high surgical risk; 52 were asymptomatic. The types of cerebral protection (a distal filter or proximal MO.MA system), stent, and technique were at the operation's discretion. Results: The radial/brachial approach was successful in 59 (98.3%) of 60 procedures; 1 case was converted to a femoral approach. Proximal protection was used in 15 cases (11 brachial, 4 radial) with severe, soft plaques, although the MO.MA system proved too short in a tall patient having a radial approach and a filter was used. Clinical success with no adverse events was 96.7% owing to 1 retinal embolism and 1 minor stroke. Vascular complications occurred in 2 (3.3%) brachial group patients. No major bleeding was encountered. Over a mean follow-up of 18.7±17.5 months, midterm event-free survival was 93%. No target vessel revascularization was necessary. Conclusion: CAS via a right radial or brachial approach is safe and effective in patients with LICA stenosis and types 1 or 2 bovine arch.

Carotid artery stenting in patients with left ICA stenosis and bovine aortic arch : a single-center experience in 60 consecutive patients treated via the right radial or brachial approach / P. Montorsi, S. Galli, P.M. Ravagnani, D. Trabattoni, F. Fabbiocchi, A. Lualdi, G. Ballerini, D. Andreini, G. Pontone, L. Caputi, A.L. Bartorelli. - In: JOURNAL OF ENDOVASCULAR THERAPY. - ISSN 1526-6028. - 21:1(2014 Feb), pp. 127-136. [10.1583/13-4491MR.1]

Carotid artery stenting in patients with left ICA stenosis and bovine aortic arch : a single-center experience in 60 consecutive patients treated via the right radial or brachial approach

P. Montorsi
;
A. Lualdi;D. Andreini;G. Pontone;A.L. Bartorelli
Ultimo
2014-02

Abstract

Purpose: To assess the safety and efficacy of carotid artery stenting (CAS) of the left internal carotid artery (LICA) from a right radial/brachial approach in patients with bovine aortic arch. Methods: Among 505 consecutive CAS patients treated at our facility between June 2007 and December 2012, 60 (11.9%) patients (44 men; mean age 73±9 years) with LICA stenosis and bovine arch were treated from a right radial (n=32) or brachial (n=28) approach. Three quarters of the patients had characteristics qualifying them at high surgical risk; 52 were asymptomatic. The types of cerebral protection (a distal filter or proximal MO.MA system), stent, and technique were at the operation's discretion. Results: The radial/brachial approach was successful in 59 (98.3%) of 60 procedures; 1 case was converted to a femoral approach. Proximal protection was used in 15 cases (11 brachial, 4 radial) with severe, soft plaques, although the MO.MA system proved too short in a tall patient having a radial approach and a filter was used. Clinical success with no adverse events was 96.7% owing to 1 retinal embolism and 1 minor stroke. Vascular complications occurred in 2 (3.3%) brachial group patients. No major bleeding was encountered. Over a mean follow-up of 18.7±17.5 months, midterm event-free survival was 93%. No target vessel revascularization was necessary. Conclusion: CAS via a right radial or brachial approach is safe and effective in patients with LICA stenosis and types 1 or 2 bovine arch.
Angioplasty; Bovine aortic arch; Brachial access; Carotid stenting; Catheterization; Cerebral protection; Left internal carotid artery; Radial access; Stenosis; Stent; Vascular access; Aged; Aged, 80 and over; Angioplasty, Balloon; Aorta, Thoracic; Aortography; Carotid Stenosis; Disease-Free Survival; Embolic Protection Devices; Female; Humans; Male; Middle Aged; Patient Selection; Radiography, Interventional; Retrospective Studies; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Brachial Artery; Carotid Artery, Internal; Radial Artery; Stents; Cardiology and Cardiovascular Medicine; Radiology, Nuclear Medicine and Imaging
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/628288
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