Abstract
This report describes a patient who presented with acute but transient right arm weakness and altered sensation secondary to severe stenosis of the left common carotid artery (CCA) origin. Endovascular stenting of the stenosed origin was achieved utilising a novel rendezvous technique through combined retrograde common carotid artery and anterograde transfemoral approaches. This technique has numerous potential advantages over traditional transfemoral endovascular and open retrograde common carotid artery approaches. It allows increased procedural control and success in traversing the stenosis and provides a smooth transition for the stent delivery catheter. An open cutdown procedure or open surgical technique is not required. Our patient recovered well from the procedure with no complications within the three-month follow up period.
Highlights
A 76-year-old male presented with transient acute onset right arm weakness and altered sensation
Extracranial carotid artery steno-occlusive disease is a major cause of recurrent ischaemic stroke, accounting for approximately 20% of all strokes.(Veith et al, 2001) The incidence of significant stenosis or occlusion affecting the origins of the aortic arch branch vessels is 0.5– 6.4%.(van de Weijer et al, 2015) The vast majority of current literature is focused on the management of internal carotid artery disease, with a relative paucity regarding the management of common carotid artery steno-occlusive disease
A retrograde CCA approach allows for easier passage across the site of stenosis into the aortic arch compared with antegrade techniques, most commonly via the common femoral artery.(Makaloski et al, 2017; Paukovits et al, 2008) The retrograde CCA technique requires extensive dilatation of the common carotid artery which typically warrants an open surgical exposure(Samaniego et al, 2015) as well as the passage of the distal end of the stent through a tightly stenosed common carotid artery origin
Summary
Extracranial carotid artery steno-occlusive disease is a major cause of recurrent ischaemic stroke, accounting for approximately 20% of all strokes.(Veith et al, 2001) The incidence of significant stenosis or occlusion affecting the origins of the aortic arch branch vessels is 0.5– 6.4%.(van de Weijer et al, 2015) The vast majority of current literature is focused on the management of internal carotid artery disease, with a relative paucity regarding the management of common carotid artery steno-occlusive disease. A retrograde CCA approach allows for easier passage across the site of stenosis into the aortic arch compared with antegrade techniques, most commonly via the common femoral artery.(Makaloski et al, 2017; Paukovits et al, 2008) The retrograde CCA technique requires extensive dilatation of the common carotid artery which typically warrants an open surgical exposure(Samaniego et al, 2015) as well as the passage of the distal end of the stent through a tightly stenosed common carotid artery origin. We present a case describing a novel antegraderetrograde rendezvous technique for stenting the left CCA origin that overcomes the aforementioned difficulties utilising a combined retrograde CCA and antegrade CFA approach in a patient with symptomatic severe left common carotid artery origin stenosis
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