Predictors of Antegrade Flow in the Internal Carotid Artery During Carotid Artery Stenting with a 7F Optimo Balloon Guide Catheter Following Common Carotid Artery Occlusion

Abstract

Background: Carotid artery stenting (CAS) using the 7F Optimo balloon guide catheter (BGC) allows for smooth navigation and facilitates proximal flow control. However, this method may allow antegrade flow in the internal carotid artery (ICA). This study aims to identify predictors of antegrade flow during CAS with the common carotid artery (CCA) occlusion.

Methods: We retrospectively analyzed 102 lesions treated with CAS using the 7F Optimo BGC and distal filter protection. The ICA flow pattern was assessed via contrast injection during CCA occlusion.

Results: Antegrade flow in the ICA was observed in 22 lesions (22%). Compared with lesions where ICA flow control (stagnation or reverse flow) was achieved, the external carotid artery (ECA) diameter was significantly larger (4.4 ± 0.7 mm vs. 3.6 ± 1.2 mm, p < 0.001), and the minimum lesion diameter was significantly larger (3.2 ± 1.2 mm vs. 2.1 ± 1.0 mm, p < 0.001). Multivariate analysis identified a minimum lesion diameter ≥ 2.1 mm (OR 4.8, 95% CI 1.44-16.1; p = 0.01) and an ECA diameter ≥ 4.2 mm (OR 3.2, 95% CI 1.08-9.09; p = 0.04) as independent predictors of antegrade flow. High-intensity spots in postoperative diffusion-weighted magnetic resonance imaging and the incidence of ischemic events were not significantly different between both groups.

Conclusions: Lesions with a minimum lesion diameter ≥ 2.1 mm or an ECA diameter ≥ 4.2 mm may exhibit antegrade ICA flow with BGC regardless of CCA occlusion, suggesting that an additional distal filter may help reduce embolic risk.

Keywords: Antegrade flow; Balloon guide catheter; Carotid artery stenting; Distal filter protection; Flow reversal.