• Piotr Pieniazek, Piotr Musialek, Karolina Dzierwa, Rafal Motyl, Mariusz Trystuła, Tadeusz Przewlocki, Anna Kabłak-Ziembicka, Lukasz Tekieli, Piotr Paluszek, Zbigniew Moczulski, Jerzy Sadowski, and Wiesława Tracz.
• Department of Cardiac and Vascular Diseases, Jagiellonian University, Krakow, Poland. kardio@kki.krakow.pl
• J. Endovasc. Ther. 2009 Dec 1;16(6):744-51.

PurposeTo report the utility of proximal brain protection by flow reversal in endovascular management of critical internal carotid artery (ICA) stenosis coexisting with ipsilateral external carotid artery (iECA) occlusion.Case ReportFour patients with a symptomatic, critical ICA stenosis (in-stent restenosis in one) and iECA occlusion were admitted for carotid artery stenting (CAS). In all cases, the stenosis severity and high-risk lesion morphology precluded the use of filter protection. The "tailored" CAS algorithm indicated that a proximal anti-embolism system should be used to maximize the potential for effective neuroprotection. The flow reversal system, which consists of an independent guiding sheath balloon positioned in the common carotid artery (CCA) and an iECA balloon-wire, was employed, using the CCA balloon only. The system was well-tolerated, and the CAS procedures were uneventful.ConclusionDue to a unique design with separate CCA and iECA balloons, the flow reversal system can be used for proximal neuroprotection during CAS in severe, symptomatic ICA lesions coexisting with iECA occlusion.

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