1369 Use of Distal Embolic Protection Devices as a Bailout Strategy for Suboptimal Flow Reversal During Transcarotid Artery Revascularization

INTRODUCTION: Transcarotid artery revascularization (TCAR) has been established as an effective surgical option for symptomatic carotid disease, relying on carotid flow reversal as a proximal neuroprotection strategy. Despite its effectiveness, carotid flow reversal may not be tolerated in certain patients. These include those with anatomic variations in the intracranial circulation, such as an isolated cerebral hemisphere, and those with multiple cranio-cervical occlusions. In other cases, efficient carotid flow reversal cannot be established with certainty, e.g., when treating a high-grade, flow-limiting carotid stenosis. METHODS: We conducted a retrospective review of a prospectively maintained database of consecutive adult patients (>18 years old) undergoing treatment for symptomatic carotid stenosis by TCAR at a single institution. Patients with adjunctive use of a DEP device during the operation were identified. Patient demographics, comorbidities, intra- and post-operative variables and complications were collected for each patient. The primary outcome was perioperative stroke rate. RESULTS: Between, adjunctive use of a DEP device was used in three patients (1.9%) undergoing TCAR for symptomatic carotid disease. All patients had high-grade, flow-limiting carotid stenoses measured by NASCET criteria. In all cases, poor retrograde flow after cross clamping was observed angiographically. A NAV6 DEP (Abbott Laboratories, Chicago, IL) was used. The average procedural time was 104 minutes. All cases were successfully completed. There were no access-related or periprocedural complications, and there were no strokes within 90-days post-procedurally. CONCLUSIONS: For patients with angiographic evidence of poor flow reversal after cross-clamping, adjunctive use of a DEP device can provide standard neuroprotection during TCAR procedures.