W. Darrin Clouse, MD, Emel A. Ergul, MS, Richard P

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Presentation transcript:

Retrograde stenting of proximal lesions with carotid endarterectomy increases risk W. Darrin Clouse, MD, Emel A. Ergul, MS, Richard P. Cambria, MD, David C. Brewster, MD, Christopher J. Kwolek, MD, Glenn M. LaMuraglia, MD, Virendra I. Patel, MD, MPH, Mark F. Conrad, MD, MMSc Journal of Vascular Surgery Volume 63, Issue 6, Pages 1517-1523 (June 2016) DOI: 10.1016/j.jvs.2016.01.028 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Preoperative computed tomography angiography reconstruction shows complex, severe, eccentric, and calcified left common carotid artery (LCCA) stenosis and left internal carotid artery (LICA) stenosis. B, Retrograde carotid arteriogram after left carotid endarterectomy (CEA), with carotid clamping marking the severe, proximal stenosis. C, Positioning of stent across the LCCA stenosis before deployment. D, Completion retrograde arteriogram after placement of a 7-mm × 22-mm bare-metal balloon-expandable stent. Journal of Vascular Surgery 2016 63, 1517-1523DOI: (10.1016/j.jvs.2016.01.028) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Dissection of the left common carotid artery (CCA) after initial predilation of proximal high-grade stenosis during endovascular intervention after carotid endarterectomy (CEA) has been accomplished. B, Completion retrograde arteriogram after 6-mm × 58-mm bare-metal balloon-expandable stent has been deployed in the origin and an 8-mm × 40-mm self-expanding stent placed in the CCA to fully treat the dissection. Journal of Vascular Surgery 2016 63, 1517-1523DOI: (10.1016/j.jvs.2016.01.028) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Stroke-free survival actuarial estimate in the cohort of 23 patients undergoing carotid endarterectomy (CEA) with ipsilateral proximal endovascular (IPE) intervention was 80% at 3 years. B, Overall survival estimate in this cohort was 85% at 4 years. SE, Standard error. Journal of Vascular Surgery 2016 63, 1517-1523DOI: (10.1016/j.jvs.2016.01.028) Copyright © 2016 Society for Vascular Surgery Terms and Conditions