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Staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion
BACKGROUND: Endovascular treatment for acute tandem occlusion (ATO) of the combination of an ipsilateral extracranial internal carotid artery (ICA) steno-occlusive lesion with concurrent intracranial artery occlusion is challenging. Whether extracranial lesions, especially in cases of the left commo...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Scientific Scholar
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326091/ https://www.ncbi.nlm.nih.gov/pubmed/34345503 http://dx.doi.org/10.25259/SNI_572_2021 |
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author | Maeoka, Ryosuke Nakagawa, Ichiro Ohnishi, Hiroyuki Ohnishi, Hideyuki |
author_facet | Maeoka, Ryosuke Nakagawa, Ichiro Ohnishi, Hiroyuki Ohnishi, Hideyuki |
author_sort | Maeoka, Ryosuke |
collection | PubMed |
description | BACKGROUND: Endovascular treatment for acute tandem occlusion (ATO) of the combination of an ipsilateral extracranial internal carotid artery (ICA) steno-occlusive lesion with concurrent intracranial artery occlusion is challenging. Whether extracranial lesions, especially in cases of the left common carotid artery (LCCA) origin steno-occlusive lesions, should be treated after recanalization of an occluded intracranial artery by mechanical thrombectomy simultaneously in the same session has not been established. We report two cases of successful ATO with LCCA origin steno-occlusive lesions treated by staged retrograde transcarotid LCCA stenting followed emergent mechanical thrombectomy in two sessions because of the tortuous aortic arch. CASE DESCRIPTION: A 61-year-old man with left ICA occlusion and an 82-year-old woman with left middle cerebral artery occlusion underwent emergent mechanical thrombectomy for ATO with LCCA origin stenoocclusive lesions. We achieved recanalization of large vessels, but severe stenosis of LCCAs remained. Because of the tortuous aortic arch, we decided to treat LCCA origin steno-occlusive lesions with staged stenting in the other session followed emergent mechanical thrombectomy. Postoperative courses were uneventful, and their symptoms improved. We performed stenting using a transcarotid approach through CCA cut down for LCCA steno-occlusive lesions without any complications. CONCLUSION: The staged strategy leaving LCCA origin stenosis seems to offer a better strategy than the simultaneous strategy for ATO with LCCA origin steno-occlusive lesions. A retrograde transcarotid approach through CCA cut down is recommended for LCCA stenting. |
format | Online Article Text |
id | pubmed-8326091 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Scientific Scholar |
record_format | MEDLINE/PubMed |
spelling | pubmed-83260912021-08-02 Staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion Maeoka, Ryosuke Nakagawa, Ichiro Ohnishi, Hiroyuki Ohnishi, Hideyuki Surg Neurol Int Case Report BACKGROUND: Endovascular treatment for acute tandem occlusion (ATO) of the combination of an ipsilateral extracranial internal carotid artery (ICA) steno-occlusive lesion with concurrent intracranial artery occlusion is challenging. Whether extracranial lesions, especially in cases of the left common carotid artery (LCCA) origin steno-occlusive lesions, should be treated after recanalization of an occluded intracranial artery by mechanical thrombectomy simultaneously in the same session has not been established. We report two cases of successful ATO with LCCA origin steno-occlusive lesions treated by staged retrograde transcarotid LCCA stenting followed emergent mechanical thrombectomy in two sessions because of the tortuous aortic arch. CASE DESCRIPTION: A 61-year-old man with left ICA occlusion and an 82-year-old woman with left middle cerebral artery occlusion underwent emergent mechanical thrombectomy for ATO with LCCA origin stenoocclusive lesions. We achieved recanalization of large vessels, but severe stenosis of LCCAs remained. Because of the tortuous aortic arch, we decided to treat LCCA origin steno-occlusive lesions with staged stenting in the other session followed emergent mechanical thrombectomy. Postoperative courses were uneventful, and their symptoms improved. We performed stenting using a transcarotid approach through CCA cut down for LCCA steno-occlusive lesions without any complications. CONCLUSION: The staged strategy leaving LCCA origin stenosis seems to offer a better strategy than the simultaneous strategy for ATO with LCCA origin steno-occlusive lesions. A retrograde transcarotid approach through CCA cut down is recommended for LCCA stenting. Scientific Scholar 2021-07-19 /pmc/articles/PMC8326091/ /pubmed/34345503 http://dx.doi.org/10.25259/SNI_572_2021 Text en Copyright: © 2021 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Case Report Maeoka, Ryosuke Nakagawa, Ichiro Ohnishi, Hiroyuki Ohnishi, Hideyuki Staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion |
title | Staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion |
title_full | Staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion |
title_fullStr | Staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion |
title_full_unstemmed | Staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion |
title_short | Staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion |
title_sort | staged strategy using a transcarotid approach for acute tandem occlusions with left common carotid artery origin steno-occlusive lesion |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326091/ https://www.ncbi.nlm.nih.gov/pubmed/34345503 http://dx.doi.org/10.25259/SNI_572_2021 |
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