Key result
Distal filter retrieval catheter enables guide sheath retracking during CAS, avoiding severe stenosis re-crossing.
Why the study?
Sheath prolapse during carotid artery stenting in patients with unfavorable anatomy and calcified lesions poses risks and requires novel rescue techniques.
Case Report
Using a distal filter retrieval catheter to retrack a prolapsed guide sheath during carotid stenting is a useful technique to minimize manipulations and embolic risk.
May aid complex carotid stenting; leaves open outcome benefits pending prospective trials.
Sheath placement prior to carotid artery stenting is usually uncomplicated, and provides sufficient support for the procedure. In certain patients, especially those with unfavorable arch anatomy, tortuous vessels, and heavily calcified lesions, the sheath backs out into the aortic arch with compromise of wire and embolic protection device (EPD) position, and risk of "dragging" the EPD back through the lesion. A novel use of the distal filter retrieval catheter to "rescue" a prolapsed guide sheath is described. Use of the filter retrieval catheter as a "body" to retrack the sheath but not recapturing the deployed filter is a useful technique, since the equipment is already available. This avoided the need to pull a retrieved filter through a severe undilated carotid stenosis, reducing the amount of manipulations needed to reposition the sheath and thus reducing the risk of embolic events.
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Chiam et al. (2008) conducted a case report in Carotid artery stenting with prolapsed guide sheath. Distal filter retrieval catheter used to retrack the sheath was evaluated. Using a distal filter retrieval catheter to retrack a prolapsed guide sheath during carotid artery stenting avoids pulling a retrieved filter through a severe stenosis, reducing embolic risk.
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