Efficacy of a proximal occlusion catheter with reversal of flow in the prevention of embolic events during carotid artery stenting: An experimental analysis

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Presentation transcript:

Efficacy of a proximal occlusion catheter with reversal of flow in the prevention of embolic events during carotid artery stenting: An experimental analysis Takao Ohki, MDa, Juan Parodi, MDb, Frank J. Veith, MDa, Mark Bates, MDa, Maseer Bade, MDc, David Chang, MDa, Manish Mehta, MDa, Joseph Rabin, MDa, Kenneth Goldstein, MDa, John Harvey, MDa, Evan Lipsitz, MDa Journal of Vascular Surgery Volume 33, Issue 3, Pages 504-509 (March 2001) DOI: 10.1067/mva.2001.112278 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 The PAEC (7F sheath) has an elastic teardrop-shaped balloon (inset ) attached at its distal end. The balloon can be inflated through one of the side ports (I ). The Y-adapter allows insertion of several devices, including Parodi External Balloon, and permits connection to sheath inserted in femoral vein, thereby creating arteriovenous fistula and reversal of flow. Journal of Vascular Surgery 2001 33, 504-509DOI: (10.1067/mva.2001.112278) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 A, Angiogram of CCA before inflation of PAEC. The thyroid artery is visualized (T ). Arrows denote direction of blood flow in each vessel. B, Angiographic image of CCA after inflation of PAEC (X ) but without activation of arteriovenous fistula and reversal of flow. Contrast was injected from tip of angioplasty balloon at the level of the thyroid artery. The thyroid artery is giving rise to prograde flow in distal CCA. Arrows denote direction of blood flow in each vessel. C, Angiographic image of CCA with PAEC occlusion and activation of arteriovenous fistula. Flow in distal common and thyroid arteries is reversed, and contrast injected through tip of angioplasty balloon is now flowing toward PAEC. D, Metallic particles and contrast material are being recovered with reversal of flow. P, Inflated balloon at tip of PAEC. Journal of Vascular Surgery 2001 33, 504-509DOI: (10.1067/mva.2001.112278) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Groin access sites in the animal. The PAEC (P ) has been inserted into CCA through a 10F sheath placed in the femoral artery. Reversal of flow is achieved by activating the shunt (S ). The shunt connects the side port of PAEC and sheath (V ) inserted in the femoral vein. Journal of Vascular Surgery 2001 33, 504-509DOI: (10.1067/mva.2001.112278) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 A, Direction of blood flow with proximal CCA occlusion only. Because ECA pressure is higher than that of ICA in most cases, prograde flow in ICA will be maintained via ECA despite inflow control. B, Because femoral vein pressure is significantly lower than both ICA and ECA pressures, reversal of flow in both carotid arteries can be obtained by activating arteriovenous shunt. Journal of Vascular Surgery 2001 33, 504-509DOI: (10.1067/mva.2001.112278) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions