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

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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.

Original languageEnglish
Pages (from-to)127-136
Number of pages10
JournalJournal of Endovascular Therapy
Volume21
Issue number1
DOIs
Publication statusPublished - Feb 2014

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Thoracic Aorta
Carotid Arteries
Pathologic Constriction
Arm
Carotid Stenosis
Internal Carotid Artery
Thigh
Embolism
Disease-Free Survival
Stents
Blood Vessels
Stroke
Hemorrhage
Safety

Keywords

  • Angioplasty
  • Bovine aortic arch
  • Brachial access
  • Carotid stenting
  • Catheterization
  • Cerebral protection
  • Left internal carotid artery
  • Radial access
  • Stenosis
  • Stent
  • Vascular access

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

@article{e2d36e554d4d4605b39325c7495e23d2,
title = "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",
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.",
keywords = "Angioplasty, Bovine aortic arch, Brachial access, Carotid stenting, Catheterization, Cerebral protection, Left internal carotid artery, Radial access, Stenosis, Stent, Vascular access",
author = "Piero Montorsi and Stefano Galli and Ravagnani, {Paolo M.} and Daniela Trabattoni and Franco Fabbiocchi and Alessandro Lualdi and Giovanni Ballerini and Daniele Andreini and Gianluca Pontone and Luigi Caputi and Bartorelli, {Antonio L.}",
year = "2014",
month = "2",
doi = "10.1583/13-4491MR.1",
language = "English",
volume = "21",
pages = "127--136",
journal = "Journal of Endovascular Therapy",
issn = "1526-6028",
publisher = "International Society of Endovascular Specialists",
number = "1",

}

TY - JOUR

T1 - Carotid artery stenting in patients with left ICA stenosis and bovine aortic arch

T2 - A single-center experience in 60 consecutive patients treated via the right radial or brachial approach

AU - Montorsi, Piero

AU - Galli, Stefano

AU - Ravagnani, Paolo M.

AU - Trabattoni, Daniela

AU - Fabbiocchi, Franco

AU - Lualdi, Alessandro

AU - Ballerini, Giovanni

AU - Andreini, Daniele

AU - Pontone, Gianluca

AU - Caputi, Luigi

AU - Bartorelli, Antonio L.

PY - 2014/2

Y1 - 2014/2

N2 - 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.

AB - 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.

KW - Angioplasty

KW - Bovine aortic arch

KW - Brachial access

KW - Carotid stenting

KW - Catheterization

KW - Cerebral protection

KW - Left internal carotid artery

KW - Radial access

KW - Stenosis

KW - Stent

KW - Vascular access

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U2 - 10.1583/13-4491MR.1

DO - 10.1583/13-4491MR.1

M3 - Article

C2 - 24502493

AN - SCOPUS:84894228581

VL - 21

SP - 127

EP - 136

JO - Journal of Endovascular Therapy

JF - Journal of Endovascular Therapy

SN - 1526-6028

IS - 1

ER -