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Percutaneous Carotid Access in Endovascular Aortic Arch Repair : Initial Experience

Karelis, Angelos LU orcid ; Mitta, Nivedita LU ; Berczeli, Márton LU orcid ; Sonesson, Björn LU and Dias, Nuno V. LU orcid (2024) In Journal of Endovascular Therapy
Abstract

Purpose: Direct percutaneous access to the carotid artery (diPerCa) during endovascular aortic arch repair (EVAAR) can potentially present a minimally invasive access with lesser local adverse events. Techniques: A retrospective review of consecutive EVAAR between January 2018 and January 2024, in a tertiary referral center, was performed to identify cases, in which diPerCa was used. Patients who were planned for EVAAR with no previous carotid intervention were included. A standardized technique was employed where an ultrasound-guided retrograde puncture of the carotid artery was performed with a micro-puncture set and a suture-mediated closure device (pre-closure technique). Of the 13 included patients, technical success was achieved... (More)

Purpose: Direct percutaneous access to the carotid artery (diPerCa) during endovascular aortic arch repair (EVAAR) can potentially present a minimally invasive access with lesser local adverse events. Techniques: A retrospective review of consecutive EVAAR between January 2018 and January 2024, in a tertiary referral center, was performed to identify cases, in which diPerCa was used. Patients who were planned for EVAAR with no previous carotid intervention were included. A standardized technique was employed where an ultrasound-guided retrograde puncture of the carotid artery was performed with a micro-puncture set and a suture-mediated closure device (pre-closure technique). Of the 13 included patients, technical success was achieved in 12 (92.3%), with one intraoperative death unrelated to diPerCa. Major complications included one case of carotid pseudoaneurysm and one case of non–flow-limiting carotid dissection. Minor complications were unilateral recurrent laryngeal nerve palsy in one case and new-onset dizziness in one case. All carotid arteries remained patent without stenosis, with one case of non-progressing dissection noted at the conclusion of the mean follow-up of 22.5±2.4 months. Conclusion: Direct percutaneous carotid access with suture-mediated closure devices during EVAAR is feasible with acceptable results and low incidence of clinically relevant neurological and local complications. Further studies are needed to confirm these findings and evaluate long-term outcomes. Clinical Impact: Direct percutaneous carotid access (diPerCa) during endovascular aortic arch repair (EVAAR) offers a minimally invasive alternative to retrograde access via open surgical exposure. This technique, supported by suture-based closure devices, demonstrates no stroke and low rates of local complications. Overall outcomes are promising, suggesting diPerCa as a feasible option for select patients. Further research is warranted to validate these findings and assess long-term outcomes.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
endovascular aortic arch repair, percutaneous carotid access, preclosure device, transcarotid access
in
Journal of Endovascular Therapy
publisher
International Society of Endovascular Specialists
external identifiers
  • pmid:39606868
  • scopus:85211577659
ISSN
1526-6028
DOI
10.1177/15266028241292456
language
English
LU publication?
yes
id
d26cbffe-a449-4443-af75-5910a48d7ab9
date added to LUP
2025-01-30 14:19:21
date last changed
2025-07-18 04:08:16
@article{d26cbffe-a449-4443-af75-5910a48d7ab9,
  abstract     = {{<p>Purpose: Direct percutaneous access to the carotid artery (diPerCa) during endovascular aortic arch repair (EVAAR) can potentially present a minimally invasive access with lesser local adverse events. Techniques: A retrospective review of consecutive EVAAR between January 2018 and January 2024, in a tertiary referral center, was performed to identify cases, in which diPerCa was used. Patients who were planned for EVAAR with no previous carotid intervention were included. A standardized technique was employed where an ultrasound-guided retrograde puncture of the carotid artery was performed with a micro-puncture set and a suture-mediated closure device (pre-closure technique). Of the 13 included patients, technical success was achieved in 12 (92.3%), with one intraoperative death unrelated to diPerCa. Major complications included one case of carotid pseudoaneurysm and one case of non–flow-limiting carotid dissection. Minor complications were unilateral recurrent laryngeal nerve palsy in one case and new-onset dizziness in one case. All carotid arteries remained patent without stenosis, with one case of non-progressing dissection noted at the conclusion of the mean follow-up of 22.5±2.4 months. Conclusion: Direct percutaneous carotid access with suture-mediated closure devices during EVAAR is feasible with acceptable results and low incidence of clinically relevant neurological and local complications. Further studies are needed to confirm these findings and evaluate long-term outcomes. Clinical Impact: Direct percutaneous carotid access (diPerCa) during endovascular aortic arch repair (EVAAR) offers a minimally invasive alternative to retrograde access via open surgical exposure. This technique, supported by suture-based closure devices, demonstrates no stroke and low rates of local complications. Overall outcomes are promising, suggesting diPerCa as a feasible option for select patients. Further research is warranted to validate these findings and assess long-term outcomes.</p>}},
  author       = {{Karelis, Angelos and Mitta, Nivedita and Berczeli, Márton and Sonesson, Björn and Dias, Nuno V.}},
  issn         = {{1526-6028}},
  keywords     = {{endovascular aortic arch repair; percutaneous carotid access; preclosure device; transcarotid access}},
  language     = {{eng}},
  publisher    = {{International Society of Endovascular Specialists}},
  series       = {{Journal of Endovascular Therapy}},
  title        = {{Percutaneous Carotid Access in Endovascular Aortic Arch Repair : Initial Experience}},
  url          = {{http://dx.doi.org/10.1177/15266028241292456}},
  doi          = {{10.1177/15266028241292456}},
  year         = {{2024}},
}