Transcervical extracorporeal reverse flow neuroprotection for reducing the risk of stroke during carotid artery stenting

3.1 Transcervical extracorporeal reverse flow neuroprotection is an approach to providing proximal neuroprotection during carotid artery angioplasty and stenting. By directly accessing the carotid artery, it aims to avoid the risks of endovascular manipulation within the aortic arch that occur with a transfemoral approach, and make access possible if there is unfavourable aortic arch anatomy or iliac artery disease.

3.2 With the patient under local, regional or general anaesthesia, a small incision is made in the neck and a catheter introduced into the common carotid artery. A catheter is then placed in the femoral or jugular vein. The common carotid artery is temporarily blocked and retrograde flow is established through the stenosis in the internal carotid artery. The blood is passed through a filtering system outside the body to remove any dislodged debris. It is then returned through the femoral or jugular vein. Once blood flow is reversed, carotid artery angioplasty and stenting are done. After the stent has been successfully placed, normal blood flow to the brain is allowed to resume and the catheters are removed.