J Cerebrovasc Endovasc Neurosurg.  2016 Jun;18(2):129-134. 10.7461/jcen.2016.18.2.129.

Trans-radial Carotid Artery Stenting in a Patient with Abdominal Aortic Occlusion

• Ha JH
• Kim H
• Park IS
• Kim SR

• KMID: 2354889
• DOI: http://doi.org/10.7461/jcen.2016.18.2.129

Abstract

We report transradial access (TRA) for emergency carotid artery stenting (CAS) as a useful alternative when the femoral artery cannot be accessed. A 63-year-old man arrived at our emergency room 30 minutes after left hemiplegia and loss of consciousness. Brain computed tomography (CT) anigograpy showed occlusion of the right interntal carotid artery (ICA) and CT perfusion revealed delayed time-to-peak in the territory of the middle cerebral artery. For, endovascular treatment, trans-femoral access (TFA) was attempted but failed due to occlusion of the abdominal aorta. So, we changed access route via radial artery and confirmed proximal ICA dissection. CAS was attempted via TRA and it was successfully performed. Final angiography showed recanalization of ICA and patient was clinically improved.

Keyword

Carotid artery; Stent; Dissection; Radial artery; Stroke

MeSH Terms

Angiography
Aorta, Abdominal
Brain
Carotid Arteries*
Emergencies
Emergency Service, Hospital
Femoral Artery
Hemiplegia
Humans
Middle Aged
Middle Cerebral Artery
Perfusion
Radial Artery
Stents*
Stroke
Unconsciousness

Figure

• 

  Fig. 1 CT angiography and perfusion showed the occlusion of Rt. ICA and marked time to peak delay in the territory of the middle cerebral artery. ICA = internal carotid artery.

• 

  Fig. 2 (A) An abdominal aortic angiogram showed an abdominal aortic occlusion just distal to the origin of the renal arteries. (B) A 100 cm, 5-Fr SIM2 diagnostic catheter was positioned at the Rt. CCA (C) After positioning of the 90 cm, 6-Fr guiding catheter at the Rt. proximal CCA, common carotid angiography revealed an dissection of the Rt. ICA. (D) A self-expanding carotid stent was deployed at the cervical ICA. Final DSA showed recanalization of the Rt. ICA. CCA = common carotid artery; ICA = interntal carotid artery; DSA = digital subtraction angiography.

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  Fig. 3 Retrograde engagement technique: as the guiding catheter is sequentially advanced for three points consisting of the brachiocephalic artery, aortic cusp, and Rt. CCA, it can be used to form a loop in the aortic cusp. CCA = common carotid artery.

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