Transcarotid artery revascularization (TCAR) stenting or angioplasty for intracranial carotid artery stenosis: Case series and novel application.
BACKGROUND: Carotid artery stenting is associated with a higher rate of stroke compared to carotid endarterectomy (CEA). This is likely due to procedural emboli resulting from plaque disruption. The transcarotid artery revascularization (TCAR) method aims to reduce the stroke rate by flow-reversal. TCAR, which has yet to be utilized for intracranial atherosclerotic disease (ICAD), may be particularly valuable given the lack of surgical treatment options for intracranial arterial stenosis.
OBJECTIVE: Presented here are five cases of angioplasty or stenting that demonstrate the feasibility of TCAR for intracranial Internal Carotid Artery (ICA) stenosis treatment.
METHODS: Five cases were reviewed retrospectively and summarized using PROCESS and CARE guidelines.
RESULTS: All patients who underwent intervention between the petrous and ophthalmic segment of the ICA had no new neurologic deficit nor detected embolic stroke. One patient experienced an asymptomatic 5 mm hemorrhage on postoperative routine Computed Tomography (CT) head imaging.
CONCLUSIONS: This highlights a new method for treating intracranial ICA stenosis with a potentially reduced stroke risk. Given the historically higher stroke rates for cervical ICA stenting compared to carotid artery endarterectomy, this method may improve the previously higher stroke rates in endovascular carotid artery treatment, compared to CEA. Although this series is small, it illustrates a novel use for a rising technique that should be further evaluated in a larger study to validate its efficacy as a new treatment modality for surgically inaccessible intracranial disease.
Published In/Presented At
Piper, K., Farooq, J., Yeung, E., Flores-Milan, G., Van Loveren, H., & Lau, T. (2022). Transcarotid artery revascularization (TCAR) stenting or angioplasty for intracranial carotid artery stenosis: Case series and novel application. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, 15910199221090724. Advance online publication. https://doi.org/10.1177/15910199221090724
Medicine and Health Sciences
Department of Surgery, USF-LVHN SELECT Program, USF-LVHN SELECT Program Students