Article Figures & Data
Figures
- Figure 1
Graphic representation of a type II aortic arch (A) and a type III aortic arch (B). These anatomical variations of the arch are defined by the vertical distance of the brachiocephalic trunk origin and the top of the arch. Specifically, in a type II aortic arch, the distance is 1–2 diameters of the left common carotid artery (LCCA), whereas in a type III arch the distance is >2 LCCA diameters.
- Figure 2
Carotid ostium stenosis (A) is usually induced by progressive atherosclerosis and/or the intramural build-up of a plaque (black circle). Kinking and coiling of the internal carotid artery (ICA) (B, left and right images, respectively) are among the diverse anomalies of this vessel. Kinking is seen most frequently among elderly people, men in particular, whereas coiling is more frequent among women. When these forms are acquired, they are associated with ageing, hypertension and the usual cardiovascular risk factors.
- Figure 3
Direct percutaneous carotid puncture can be performed under conscious sedation or general anaesthesia with the head turned to the contralateral side by 10°–15°. The puncture site on the CCA can be assessed by palpation between the index and the middle finger or with the aid of ultrasound. Ideally, CCA puncture should be 2–3 cm above the superior edge of the clavicle, which is approximately at the C5–C6 level (black star). The skin is punctured, and a needle is inserted at a 45°–60° angle. This part of the procedure can also be performed under roadmap control using a 4F access sheath. CCA, common carotid artery.
- Figure 4
When surgical cut-down technique is chosen to gain direct access to the carotid artery, the common carotid artery is isolated proximally and distally to the chosen puncture site and the vessel loops are placed around it (A). The needle is then advanced with a flat angle into the vessel under visual control and a purse-string suture is placed at the puncture site (A). The remaining steps recapitulate those of the percutaneous puncture of the carotid artery (B).
Tables
- Table 1
Patient demographics and data on stroke event
Author Year Sex Age Aorta Femoral artery Carotid artery First choice Stroke Side tPA Technique TICI Closure Success Haematoma Dissection Kinking ASPECT NIHSS mRs Roche et al 22 2017 F 73 Coarctation with multiple aneurysms 0 Occlusion left ICA 1 M1 Right 1 Retriever 3 Manual 1 0 0 0 10 23 0 Jadhav et al 20 2014 NA 80 0 Athero 0 0 M1 Left 0 Aspiration 2b Mynx 0 1 0 0 10 10 4 NA 80 0 Athero 0 0 M1 Left 0 Aspiration 3 Mynx 0 0 0 0 8 27 4 NA 60 0 Athero 0 0 M1 Left 0 Aspiration 2b Manual 1 0 0 0 9 9 4 NA 70 Bovine type III arch 0 0 0 ICA Left 0 Retriever 2a Manual 1 0 0 0 10 22 6 NA 70 0 Athero 0 0 M1 Left 1 Aspiration 2b Manual 1 0 0 0 10 17 0 NA 80 Severely tortuous arch 0 0 1 M1 Left 0 Retriever 2b Manual 1 0 0 0 9 20 2 NA 80 0 Athero 0 0 M1 Left 0 Aspiration 3 Manual 1 0 0 0 8 21 4 Benichi et al 25 2019 M 60 0 0 Occlusion right CCA 1 M1 Left 0 Aspiration 3 Angio-Seal 1 0 1 0 NA 19 NA Mokin et al 21 2015 NA NA Type III arch 0 Right CCA tortuosity 1 M1 Right 0 Aspiration 3 NA NA 0 0 0 NA 14 0 NA NA 0 0 Right CCA tortuosity 1 M1 Right 0 Aspiration 2a NA NA 0 0 1 NA 12 NA Castaño et al 24 2016 F 80 0 Athero 0 0 M1 Left 0 Aspiration 3 Angio-Seal 1 0 0 0 7 11 0 Roche et al 23 2019 NA NA NA NA NA 0 M1 Right 1 Retriever 3 Angio-Seal 1 0 0 0 10 23 0 NA NA NA NA NA 0 M2 Left 0 Retriever 3 Angio-Seal 1 0 0 0 8 28 6 NA NA NA NA NA 0 M2 Right 0 Retriever 2b Angio-Seal 1 0 0 0 9 22 3 NA NA NA NA NA 0 M1 Left 1 Retriever 2b Angio-Seal 1 0 0 0 10 14 6 NA NA NA NA NA 0 M1 Right 1 Retriever 2c Angio-Seal 1 0 0 0 7 14 4 NA NA NA NA NA 0 M1 Left 1 Retriever 3 Angio-Seal 0 1 1 0 9 23 6 NA NA NA NA NA 0 ICA, M1 Right 1 None 0 Angio-Seal 1 0 0 0 10 12 4 NA NA NA NA NA 0 ICA Left 1 None 0 Manual 1 NA NA NA 10 20 4 NA NA NA NA Left ICA stenosis 0 M1 Left 1 Retriever 3 Angio-Seal 1 0 0 0 10 21 0 NA NA NA NA NA 0 M1 Left 1 Retriever Sp Angio-Seal 1 0 0 0 8 19 3 NA NA NA NA NA 0 ICA Right 1 Retriever 3 Angio-Seal 1 0 0 0 NA NA 6 ASPECT, Alberta stroke programme early CT score; Athero, athersclerosis; CCA, common carotid artery; F, female; ICA, internal carotid artery; M, male; mRS, modified Rankin scale; NA, not available; NIHSS, National Institutes of Health Stroke Scale; Sp, spontaneous recanalization; TICI, Thrombolysis in Cerebral Infarction; tPA, tissue plasminogen activator.
