DIRECT CAROTID STENT ANGIOPLASTY WITH FLOW REVERSAL (TCAR)
A NEW AND SAFER APPROACH TO CAROTID ARTERY STENTING
STEPS FOR DEPLOYMENT
- The common carotid artery, above the clavicle, is exposed through a small transverse incision using local anesthesia.
- The artery is punctured and a sheath is inserted over a guide wire.
- The patient is systemically heparinized.
- Percutaneous access is obtained to the femoral vein and a sheath is inserted.
- The arterio-venous shunt line is connected between the Transcervical Arterial Sheath and the Venous Return Sheath.
- A carotid angiogram is obtained thru the Transcervical Arterial Sheath and the carotid stenosis is measured and marked.
- The common carotid artery is clamped proximal to the sheath entry site and the patient’s tolerance to clamping is assessed by interaction with the patient awake.
- Flow reversal is controlled by adjusting the valve on the flow controller.
- A guide wire is introduced through the arterial sheath and passed across the lesion.
- A stent of appropriate size is passed over the guide wire and positioned across the lesion.
- The stent is deployed and secondarily expanded with a balloon while flow reversal is taking place, allowing any thrombo-atheromatous debris to be carried away through the arterio-venous shunt.
- A completion angiogram is obtained to confirm the anatomic result.
- The catheters, guide wire and sheaths are removed, and the arterial puncture site is closed with a Prolene suture.
- The small neck incision is closed with a sub-cuticular suture and the patient is returned to a hospital room for overnight observation and discharge the following day.
