Transfemoral CAS and TCAR

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Presentation transcript:

Transfemoral CAS and TCAR Carotid Stenting Transfemoral CAS and TCAR Leila Mureebe, MD, MPH, FACS Division of Vascular and Endovascular Surgery Duke University Health Care

Agenda: I. Inclusion/Exclusion Criteria II. Anatomy & Physiology Overview III. Live abstraction

Inclusion/Exclusion Criteria: Carotid artery stents that involve the carotid bifurcation or are isolated to the internal, external, or common carotid artery that may be performed by percutaneous or open (cut down) approach. Both primary and redo stenting is included. Unlike other procedures, stenting for trauma is also included. Typically, the carotid bifurcation or internal carotid artery is treated, but sometimes an isolated common carotid stenosis is treated alone, or in combination with a bifurcation/internal carotid stent. Rarely the external carotid is treated but we are including it to meet CAS recertification requirements. The data entry form allows any of the four locations to be recorded for compliance with CMS Carotid Stent reporting. If the procedure failed when attempting to place the long sheath in the CCA, this should be recorded as a “technical failure” on the procedure tab. If bilateral Carotid Artery Stent procedures are done on the same day, please enter as two separate procedures. Exclusions Intracranial Carotid Artery stents (above C1) Carotid Artery Stents placed for bleeding or infection

Carotid Anatomy and Physiology Source: Wikimedia Commons

Arch Anatomy

CAS Example

TCAR

Dynamic Flow Reversal For ROBUST Neuroprotection Direct carotid access reduces embolic risks of transfemoral catheter advancement Continuous high rate of flow reversal to remove debris throughout intervention A new, surgically inspired, endovascular solution for carotid artery revascularization comes to us from Silk Road Medical. Through a small surgical cutdown, the ENROUTE Transcarotid Stent and Neuroprotection Systems deliver an endovascular dynamic flow reversal system for continuous, robust stroke protection. This new, direct carotid access method provides surgical patient outcomes with unique transcarotid speed and control. The avoiding the more critical crainial nerve bundle in the typical longer CEA incision. CAUTION: Investigational device. Limited by federal (USA) law to investigational use. The ENROUTE™ Transcarotid Stent and Neuroprotection Systems bear the CE mark of conformity and are available for sale in EU and EFTA countries.

Filter Contents

TCAR Indications and Contraindications : Focus on Safe Access

Case Abstraction: Transfemoral CAS https://pathways-demo.m2s.com USER: VAM2019 Password: #1registry Patient Last Name: CAS

Case Abstraction: TCAR https://pathways-demo.m2s.com USER: VAM2019 Password: #1registry Patient Last Name: TCAR

Questions