Reverse flow-enhanced catheterization of true lumen in carotid artery dissection: the REFLECT technique.

Endovascular treatment of large vessel occlusion (LVO) caused by carotid artery dissection (CAD) is challenging due to difficulties in identifying and navigating the true lumen. Entering through the false lumen can complicate the procedure, increasing the risk of distal embolization into patent arteries and hindering access to the LVO. We report a case of CAD causing middle cerebral artery (MCA) occlusion, successfully managed with mechanical thrombectomy using a balloon guide catheter. Proximal flow arrest in the dissected carotid artery enabled flow reversal, promoting collapse of the false lumen and improving visualization and access to the true lumen-an approach we term REFLECT technique (Reverse Flow-Enhanced Catheterization of True Lumen in Carotid Artery Dissection). Once the guiding catheter was advanced into the distal healthy carotid segment, intracranial circulation was revascularized. Carotid stents were then deployed within the true lumen to reconstruct the dissected artery and maintain long-term patency.