Journal of Korean Society of Geriatric Neurosurgery 2016;12(1):63-65.
Published online June 30, 2016.
Direct Carotid Access for Carotid Angioplasty and Stenting of an Elderly Patient: Case Report and Review of Literatures
Yuhee Kim , Chan-Jong Yoo , Cheol Wan Park , Myeong Jin Kim
Department of Neurosurgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
Abstract
Carotid artery stenting (CAS) is usually performed by a transfemoral approach. In elderly patients with tortuous vasculature is a main cause of failure of the endovascular procedures. When the patient's anatomy forbids this or other distal access to the carotids, a direct access may be useful. We present our carotid angioplasty and stenting with a direct carotid puncture after a cut-down of the common carotid artery. A 75-year-old male with amaurosis fugax had severe stenosis involving the left internal carotid artery. CAS was planned, but arterial tortuosity prevented a guiding catheter from being introduced into the left common carotid artery. Following this, the left common carotid artery was exposed with a small skin incision, and a direct carotid puncture was made. An 8-French sheath was carefully advanced and positioned into the left common carotid artery and a self-expandable stent was delivered through it. Direct cervical arterial approach is an effective alternative to transfemoral artery access in geriatric patients in whom the femoral route does not allow the navigation and stabilization of guiding catheters because of unfavorable aortic arch, carotid tortuosity, or severe stenotic lesions involving the ostia or proximal arteries.
Key Words: Carotid stenosisㆍGeriatricsㆍEndovascular techniques


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