Presenter: Tommaso Castrucci

Affiliation: Ospedale Sant'Eugenio, Rome, Italy

Abstract

This article presents a 75-year-old male with left ICA stenosis (75%) treated by carotid artery stenting (CAS) via brachial access under flow reversal cerebral protection. The CGuard EPS stent achieved optimal revascularization without complications, demonstrating the safety of alternative access in complex anatomies.

Introduction

Brachial access offers a viable alternative for CAS in patients with challenging femoral anatomy. This case highlights its application in a high-risk patient with bovine arch and anticoagulation needs.

Case Study

The patient had hypertension, atrial fibrillation, and transient drop attacks.

Intervention included:

Brachial Access: 8F sheath placement with FlowGate 2 for cerebral protection.

Stent Deployment: 10×40mm CGuard EPS stent with post-dilation.

Hemodynamic Control: A-V connection maintained retrograde flow during balloon inflation.

Post-procedural imaging confirmed stent patency and normalized ICA velocity.

Conclusions

1.Brachial access is safe for CAS in anatomically complex cases.

2.Flow reversal minimizes embolic risks during stent deployment.

3.Real-time hemodynamic monitoring ensures procedural success.