Carotid artery stenting under flow arrest for the management of intraluminal thrombus: technical case report.

Ramachandra P. Tummala*, Babak S. Jahromi, Junichi Yamamoto, Elad I. Levy, Adnan H. Siddiqui, L. Nelson Hopkins

*Corresponding author for this work

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECTIVE: The management of intraluminal carotid thrombus is not well defined. Medical and surgical management carry a relatively high risk of thromboembolism. Although endovascular options also carry the risk of thromboembolism from manipulation of the lesion, successful carotid stent placement using various methods of flow restriction has been reported anecdotally. We describe a technique to arrest antegrade flow before placement of carotid stents in the setting of symptomatic intraluminal thrombus. CLINICAL PRESENTATION: A 49-year-old woman presented with expressive dysphasia, right-upper extremity weakness, and an episode of left monocular blindness. Angiography confirmed the presence of a large intraluminal thrombus in a chronic dissection of the left internal carotid artery. RESULTS: We devised a configuration to arrest antegrade flow in the internal carotid artery before crossing the thrombus with a distal embolic protection device by inflating balloons in the common carotid artery and external carotid artery before crossing the lesion. After inflation of a balloon in the internal carotid artery, we completed overlapping stent placement to completely exclude the thrombus from the lumen. CONCLUSION: The patient remained neurologically unchanged during and immediately after the procedure. She had mild neurological deficits at the 1 month follow-up evaluation. Follow-up ultrasonography at 1 and 3 months and computed tomographic angiography at 3 months after the procedure showed patency of the stented carotid artery, with no evidence of restenosis or thrombus. Although the risks of carotid stent placement for intraluminal thrombus remain unclear, the technique of flow arrest seems to provide a safe endovascular treatment option.

Original languageEnglish (US)
Pages (from-to)ONSE87-88; discussion ONSE88
JournalNeurosurgery
Volume63
Issue number1 Suppl 1
StatePublished - Jul 2008

Fingerprint

Carotid Arteries
Thrombosis
Stents
Thromboembolism
Internal Carotid Artery
Angiography
Embolic Protection Devices
Internal Carotid Artery Dissection
External Carotid Artery
Aphasia
Common Carotid Artery
Economic Inflation
Blindness
Upper Extremity
Ultrasonography

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Tummala, R. P., Jahromi, B. S., Yamamoto, J., Levy, E. I., Siddiqui, A. H., & Hopkins, L. N. (2008). Carotid artery stenting under flow arrest for the management of intraluminal thrombus: technical case report. Neurosurgery, 63(1 Suppl 1), ONSE87-88; discussion ONSE88.
Tummala, Ramachandra P. ; Jahromi, Babak S. ; Yamamoto, Junichi ; Levy, Elad I. ; Siddiqui, Adnan H. ; Hopkins, L. Nelson. / Carotid artery stenting under flow arrest for the management of intraluminal thrombus : technical case report. In: Neurosurgery. 2008 ; Vol. 63, No. 1 Suppl 1. pp. ONSE87-88; discussion ONSE88.
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Tummala, RP, Jahromi, BS, Yamamoto, J, Levy, EI, Siddiqui, AH & Hopkins, LN 2008, 'Carotid artery stenting under flow arrest for the management of intraluminal thrombus: technical case report.', Neurosurgery, vol. 63, no. 1 Suppl 1, pp. ONSE87-88; discussion ONSE88.

Carotid artery stenting under flow arrest for the management of intraluminal thrombus : technical case report. / Tummala, Ramachandra P.; Jahromi, Babak S.; Yamamoto, Junichi; Levy, Elad I.; Siddiqui, Adnan H.; Hopkins, L. Nelson.

In: Neurosurgery, Vol. 63, No. 1 Suppl 1, 07.2008, p. ONSE87-88; discussion ONSE88.

Research output: Contribution to journalArticle

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AU - Tummala, Ramachandra P.

AU - Jahromi, Babak S.

AU - Yamamoto, Junichi

AU - Levy, Elad I.

AU - Siddiqui, Adnan H.

AU - Hopkins, L. Nelson

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N2 - OBJECTIVE: The management of intraluminal carotid thrombus is not well defined. Medical and surgical management carry a relatively high risk of thromboembolism. Although endovascular options also carry the risk of thromboembolism from manipulation of the lesion, successful carotid stent placement using various methods of flow restriction has been reported anecdotally. We describe a technique to arrest antegrade flow before placement of carotid stents in the setting of symptomatic intraluminal thrombus. CLINICAL PRESENTATION: A 49-year-old woman presented with expressive dysphasia, right-upper extremity weakness, and an episode of left monocular blindness. Angiography confirmed the presence of a large intraluminal thrombus in a chronic dissection of the left internal carotid artery. RESULTS: We devised a configuration to arrest antegrade flow in the internal carotid artery before crossing the thrombus with a distal embolic protection device by inflating balloons in the common carotid artery and external carotid artery before crossing the lesion. After inflation of a balloon in the internal carotid artery, we completed overlapping stent placement to completely exclude the thrombus from the lumen. CONCLUSION: The patient remained neurologically unchanged during and immediately after the procedure. She had mild neurological deficits at the 1 month follow-up evaluation. Follow-up ultrasonography at 1 and 3 months and computed tomographic angiography at 3 months after the procedure showed patency of the stented carotid artery, with no evidence of restenosis or thrombus. Although the risks of carotid stent placement for intraluminal thrombus remain unclear, the technique of flow arrest seems to provide a safe endovascular treatment option.

AB - OBJECTIVE: The management of intraluminal carotid thrombus is not well defined. Medical and surgical management carry a relatively high risk of thromboembolism. Although endovascular options also carry the risk of thromboembolism from manipulation of the lesion, successful carotid stent placement using various methods of flow restriction has been reported anecdotally. We describe a technique to arrest antegrade flow before placement of carotid stents in the setting of symptomatic intraluminal thrombus. CLINICAL PRESENTATION: A 49-year-old woman presented with expressive dysphasia, right-upper extremity weakness, and an episode of left monocular blindness. Angiography confirmed the presence of a large intraluminal thrombus in a chronic dissection of the left internal carotid artery. RESULTS: We devised a configuration to arrest antegrade flow in the internal carotid artery before crossing the thrombus with a distal embolic protection device by inflating balloons in the common carotid artery and external carotid artery before crossing the lesion. After inflation of a balloon in the internal carotid artery, we completed overlapping stent placement to completely exclude the thrombus from the lumen. CONCLUSION: The patient remained neurologically unchanged during and immediately after the procedure. She had mild neurological deficits at the 1 month follow-up evaluation. Follow-up ultrasonography at 1 and 3 months and computed tomographic angiography at 3 months after the procedure showed patency of the stented carotid artery, with no evidence of restenosis or thrombus. Although the risks of carotid stent placement for intraluminal thrombus remain unclear, the technique of flow arrest seems to provide a safe endovascular treatment option.

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Tummala RP, Jahromi BS, Yamamoto J, Levy EI, Siddiqui AH, Hopkins LN. Carotid artery stenting under flow arrest for the management of intraluminal thrombus: technical case report. Neurosurgery. 2008 Jul;63(1 Suppl 1):ONSE87-88; discussion ONSE88.