Percutaneous Common Carotid Artery Access for Stenting of a Critical Left Internal Carotid Artery Stenosis in a Nonagenarian: A

Purpose. To describe the successful endovascular treatment using direct carotid artery access in a high risk elderly patient with symptomatic internal carotid artery stenosis. Case Report. A 98 year-old man who was independent and lived alone was admitted to our hospital for symptoms of progressive weakness, associated with disorientation and difficulty with speech. Duplex carotid ultrasound was performed which revealed a totally occluded right internal carotid artery and high grade stenosis of the left internal carotid artery. Because of his advanced age he was deemed to be at high surgical risk for a standard endarterectomy, thus he was referred for carotid artery stenting.Using the femoral artery approach, multiple guiding catheters and sheaths were advanced to the left common carotid artery. Adequate support for intervention could not be obtained. The procedure was aborted and the patient was referred for carotid endarterectomy. However, due to his advanced age, he felt that surgery was too high risk thus he chose an alternative attempt to endovascular carotid stenting.Therefore, he was brought back to the catheterization laboratory two days later for direct carotid access. Carotid artery stenting was accomplished with a 6F sheath, a cerebral protection device and a Nitinol stent all percutaneously via the left common carotid artery. The patient was discharged the following day without complications. At 3-month follow-up, the patient is functional and independent without recurrence of symptoms. Conclusion. Direct carotid access can be successfully accomplished in patients if the femoral artery approach is anatomically prohibitive. In those of advanced age or other high risks for surgery, direct carotid access can be considered an option for revascularization.