Korean Circ J.  2018 Feb;48(2):97-113. 10.4070/kcj.2017.0208.

Carotid Artery Stenting

• Park JH
• Lee JH

• KMID: 2403158
• DOI: http://doi.org/10.4070/kcj.2017.0208

Abstract

Carotid artery stenosis is relatively common and is a significant cause of ischemic stroke, but carotid revascularization can reduce the risk of ischemic stroke in patients with significant symptomatic stenosis. Carotid endarterectomy has been and remains the gold standard treatment to reduce the risk of carotid artery stenosis. Carotid artery stenting (CAS) (or carotid artery stent implantation) is another method of carotid revascularization, which has developed rapidly over the last 30 years. To date, the frequency of use of CAS is increasing, and clinical outcomes are improving with technical advancements. However, the value of CAS remains unclear in patients with significant carotid artery stenosis. This review article discusses the basic concepts and procedural techniques involved in CAS.

Keyword

Carotid artery stenting; Percutaneous coronary intervention; Carotid stenosis

MeSH Terms

Carotid Arteries*
Carotid Stenosis
Constriction, Pathologic
Endarterectomy, Carotid
Humans
Methods
Percutaneous Coronary Intervention
Stents*
Stroke

Figure

• 

  Figure 1 Types I, II, and III aortic arches on magnetic resonance angiograms of 3 patients with symptomatic significant left proximal internal carotid artery stenosis. The type of aortic arch is based on the vertical distance between the origin of the brachiocephalic artery (dotted line) and the top of the arch (solid line). In type I, this distance is less than 1 LCCA diameter. In type II, the distance is between 1 and 2 LCCA diameters, and in type III, the distance is greater than 2 LCCA diameters. Pre-procedural aortic arch evaluation using magnetic resonance angiograms not only helps to distinguish arch type, but also reduces the use of contrast agent by eliminating an aortogram from the procedure. LCCA = left common carotid artery.

• 

  Figure 2 Engagement methods with the Simmons catheter. (A) If the Simmons catheter is inserted into the opposite iliac artery and then pushed toward the abdominal aorta, an inverted U-shaped curve of the catheter can be made. (B) After entering the left subclavian artery, the Simmons catheter can be flexed, or the catheter can be forced into curved flexion by pushing it with the support of the aorta. (C) The Simmons catheter can be introduced into either the innominate or left carotid arterial ostium by rotating and manipulating and can subsequently be deeply engaged with slow withdrawal of the catheter.

• 

  Figure 3 Schematic illustration of EPDs. (A) Distal balloon occlusion device, (B) distal filter protection device, (C) proximal protection device. EPD = embolic protection device.

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