Transfemoral endovascular treatment of atherosclerotic stenotic lesions of the left common carotid artery ostium: case series and review of the literature.

OBJECTIVE

Endovascular treatment of atherosclerotic stenosis of the left common carotid artery ostium (LCCAO) represents a technical challenge. Unlike stenting of other supra-aortic trunk lesions, LCCAO stenting is not able to be performed from a retrograde approach through the brachial artery. Stenting may be performed via a retrograde approach with a carotid artery cut-down or with total endovascular technique via a transfemoral approach. A consecutive case series is presented to demonstrate the feasibility and safety of the endovascular transfemoral LCCAO stenting technique.

METHODS

Our prospectively maintained database of elective neuroendovascular procedures was searched for cases of LCCAO angioplasty and stenting for atherosclerotic stenosis performed between January 2003 and April 2012. Cases identified were isolated and analyzed for clinical and anatomic data. The primary outcome of interest was the incidence of periprocedural (30-day) neurological or cardiopulmonary complications.

RESULTS

Fourteen patients were treated with a transfemoral approach (mean arterial stenosis 72%; symptomatic lesions 86%). Six (43%) had tandem stenosis of the proximal left internal carotid artery. In these cases, embolic protection was used. Stent revascularization was a technical success in all 14 patients, resulting in <20% residual stenosis in each. One intraprocedural complication (transient ischemic attack) was noted in a patient with symptomatic stenosis. One additional patient was identified who was treated with retrograde stenting due to bilateral leg amputations and no femoral access, with no periprocedural complication.

CONCLUSIONS

In our experience, transfemoral stenting of stenotic LCCAO lesions is feasible and no permanent neurological or cardiopulmonary sequelae occurred in 14 patients treated with this technique.