Cerebral Protection Using Percutaneous Normothermic Bilateral Antegrade Cerebral Perfusion During Total Arch TEVAR in a Patient With Shaggy Aorta

Purpose: To report a technique of global cerebral embolic protection (CEP) designed for use during thoracic endovascular aortic repair (TEVAR). Technique: Arterial cannulas are inserted percutaneously in the right axillary artery (12-F) and left common carotid artery (LCCA; 10-F) to provide normothe...

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Published in:Journal of endovascular therapy 2020-06, Vol.27 (3), p.405-413
Main Authors: Joseph, George, Pillai, Rahul, Shukla, Vinayak, Babu, Krothapalli S., Manickam, Shankar, Thomson, Viji Samuel, Kuruvilla, Korah T., Thankachen, Roy, Joseph, Elizabeth, Sahajanandan, Raj
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cited_by cdi_FETCH-LOGICAL-c304t-f0ce6654b1cce039f9195bc94de1f95551fbd79ee54c9b6a99a28e3c8b9ff8053
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container_end_page 413
container_issue 3
container_start_page 405
container_title Journal of endovascular therapy
container_volume 27
creator Joseph, George
Pillai, Rahul
Shukla, Vinayak
Babu, Krothapalli S.
Manickam, Shankar
Thomson, Viji Samuel
Kuruvilla, Korah T.
Thankachen, Roy
Joseph, Elizabeth
Sahajanandan, Raj
description Purpose: To report a technique of global cerebral embolic protection (CEP) designed for use during thoracic endovascular aortic repair (TEVAR). Technique: Arterial cannulas are inserted percutaneously in the right axillary artery (12-F) and left common carotid artery (LCCA; 10-F) to provide normothermic antegrade cerebral perfusion during TEVAR with neuromonitoring. Inferior vena cava blood is drawn using a 19-F femoral cannula, filtered, oxygenated, and delivered through independent roller pumps to the arterial cannulas. Static CEP is obtained by balloon occlusion of the 3 aortic arch branches proximally, resulting in complete separation of aortic and cerebral blood flow; static CEP is used during aortic endograft delivery and deployment. Dynamic CEP, obtained by creating flow reversal in the innominate artery and proximal LCCA, is used at all other times. Successful use of this CEP technique is illustrated in a patient with shaggy aorta undergoing fenestrated total arch TEVAR. Conclusion: Percutaneous normothermic bilateral antegrade cerebral perfusion provides effective CEP during TEVAR.
doi_str_mv 10.1177/1526602820915940
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title Cerebral Protection Using Percutaneous Normothermic Bilateral Antegrade Cerebral Perfusion During Total Arch TEVAR in a Patient With Shaggy Aorta
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