総頚動脈起始部狭窄症に対する経大腿動脈アプローチによるステント留置術の2例

Abstract

Stenosis of the proximal common carotid artery (pCCA) is rare. It is difficult to treat by surgical or endovascular revascularization, and there are few published cases. In rare cases, the pCCA stenosis is concomitant with stenosis of the internal carotid artery (ICA) and it can be difficult to determine which is the truly symptomatic lesion in such cases. Current treatment of pCCA stenosis includes alternative vascular access routes like the combined use of carotid endarterectomy and retrograde angioplasty with or without stenting. We report the method of percutaneous transfemoral approach for pCCA revascularization with stent supported by two guidewires. The guiding catheter is placed proximal to the ostium of the narrow pCCA with a co-axial method. First, the balloon type embolic protection device is introduced in the ICA to prevent embolic stroke and after, a 0.014 inch supporting stiff guidewire is carefully passed through the pCCA stenosis and placed in the external carotid artery (ECA). Finally, a balloon-expanding stent is advanced to the pCCA stenosis guided by both the protection device wire positioned in the ICA, and the supporting microguidewire positioned in the ECA. The two-guidewire technique provides a safer and more stable condition for the procedure, increasing its success rate. We discuss the etiology and endovascular treatment of the proximal carotid artery stenosis, and review the literature.