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Proximal protection devices for carotid artery stenting - A benchtop assessment of flow reversal performance.

AJNR Am J Neuroradiol

January 2025

From the Department of Radiology (J.L., E.A.B., C.B., J.C., R.K., W.B., D.F.K), and Department of Neurologic Surgery (Y.C.S., R.K., W.B.), Mayo Clinic, Rochester, MN, United States; Department of Stroke Research (J.L.), Vall d'Hebron Research Institute, Barcelona, Spain; From the Global Institute of Future Technology (Y.L.), Shanghai Jiao Tong University, Shanghai, China; Department of Neurointerventional Radiology (J.C.), Bicetre University Hospital, Le Kremlin Bicetre, France.

Background And Purpose: Proximal protection devices, such as TransCarotid Artery Revascularization (TCAR, SilkRoad Medical, Sunnyvale), aim to yield better outcomes in carotid artery stenting (CAS) than distal protection devices by preventing plaque embolization to the brain. However, transfemoral catheters may not fully reverse flow from the external carotid artery (ECA) to the internal carotid artery (ICA). We assess a new balloon-sheath device, Femoral Flow Reversal Access for Carotid Artery Stenting (FFRACAS), for this purpose.

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Background And Objective: Radiosurgery can serve as a primary, adjuvant, or salvage treatment modality for cavernous sinus tumors (CST), providing high tumor control. However, particularly with cavernous sinus expansion, there may be insufficient distance from the optic apparatus to perform radiosurgery safely. The internal carotid artery adjacent to the distal dural ring (ICAddr), when enhancing similarly to the CST, can be difficult to delineate, and can lead to over-contouring of target volume near the optic nerve and therefore increasing the risk of radiation-induced optic toxicity.

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Accessory posterior cerebral artery as a duplicate anterior choroidal artery.

Surg Radiol Anat

January 2025

Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido, 060-8570, Japan.

Purpose: Anatomical variations in the anterior choroidal artery (AChA) and/or the posterior cerebral artery (PCA) are rare. Hyperplastic AChA is an anatomical variant supplying both the AChA area and the PCA area. In accessory PCA, a hyperplastic AChA supplies part of the PCA territory.

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Introduction In the realm of Carotid Artery Stenting (CAS), various access methods such as Transfemoral access (TFA), Transradial Artery access (TRA), and Transbrachial access (TBA) have been employed. While TFA is widely established, TRA and TBA offer alternative options. TBA lacks comprehensive studies, and there is a notable lack of comprehensive evidence systematically evaluating its outcomes.

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Aim: Ischemic stroke remains one of the leading causes of death and disability worldwide and ca-rotid stenosis is the leading etiology of ischemic strokes of non-cardiac origin. The chronic inflammatory process and pro-inflammatory state in carotid stenosis seem to be the most im-portant underlying factor in carotid occlusion. In addition to medical therapy and carotid ar-tery stunting (CAS) in the treatment of carotid stenosis, carotid endarterectomy (CEA) is the main surgical treatment of carotid stenosis and its prognosis is the main subject of our study.

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