Neurointervention.  2021 Nov;16(3):260-266. 10.5469/neuroint.2021.00353.

CaRotid Artery Filtering Technique (CRAFT): A Technique for Carotid Artery Stenting with Intrinsic Embolic Protection

• Foo M
• Ren Y
• Gajera J
• Barras CD
• Kok HK
• Jhamb A
• Abbouchie H
• Maingard J
• Brooks DM
• Asadi H

• KMID: 2522040
• DOI: http://doi.org/10.5469/neuroint.2021.00353

Abstract

Purpose
Carotid artery stenting (CAS) is an established treatment for symptomatic carotid artery stenosis as an alternative to carotid endarterectomy. A variety of techniques and devices have been devised to minimise periprocedural stroke risk using either proximal or distal embolic protection. This study presents a method of embolic protection during CAS–the CaRotid Artery Filtering Technique (CRAFT).
Materials and Methods
The CRAFT technique employs aspects of both proximal and distal embolic protection. The CASPER RX stent (MicroVention, Tustin, CA, USA), which is a double-layered, closed-cell, micromesh nitinol stent, is deployed across the carotid artery stenosis with the assistance of a FlowGate balloon guide catheter (Stryker Neurovascular, Fremont, CA, USA). The partially deployed stent acts as a distal filter while the balloon guide is deflated midway during stent deployment to prevent distal plaque embolisation, followed by completion of stent deployment and angioplasty.
Results
A total of 94 patients underwent CAS using the CRAFT technique between June 2016 and March 2021. Successful stent deployment was achieved in all patients. Preliminary results demonstrated acute stent occlusion in 6 patients (6.4%) and distal embolic stroke in 5 patients (5.3%). The median procedural fluoroscopy time was 34 minutes with an interquartile range of 22 to 55 minutes.
Conclusion
The CRAFT technique of CAS presented by this study can be applied in the treatment of symptomatic carotid artery stenosis in both emergency and elective procedure settings with a high technical success and low distal embolic stroke risk.

Keyword

Carotid arteries; Stents; Radiology; Interventional

Figure

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  Fig. 1. Diagrammatic stepwise breakdown of deploying CASPER RX stent (MicroVention, Tustin, CA, USA) with the assistance of balloon across carotid artery stenosis (CaRotid Artery Filtering Technique, CRAFT). (A) FlowGate Balloon Guide Catheter (BGC) (Stryker Neurovascular, Kalamazoo, MI, USA) and its supplied inner catheter are advanced to the internal carotid artery (ICA), just proximal to the lesion and lesion crossed by guidewire. (B) BGC inflated in ICA causing an arrest of antegrade flow. (C) A CASPER RX stent introduced over the guidewire into the ICA, distal to the lesion and partially deployed. (D) BGC is deflated to restore antegrade flow. (E) Stent is completely deployed into the ICA and CCA. Red arrow indicates direction of blood flow.

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  Fig. 2. (A) EPD does not fully appose the vessel wall leading to embolus bypassing EPD. (B) Stent fully appose vessel wall. Red arrow indicates direction of blood flow. EPD, embolic protection devices; CRAFT, CaRotid Artery Filtering Technique.

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