{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:29:33Z","timestamp":1786494573415,"version":"build-2736575974"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,8,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Transcarotid artery revascularization (TCAR) has become an increasingly utilized surgical option for carotid disease, relying on flow reversal for distal embolic protection (DEP). However, anatomical variations, such as an isolated middle cerebral artery hemisphere, and severe carotid stenosis may compromise the safety of flow reversal intraoperatively. The authors describe the use of an adjunctive DEP device during TCAR as a \u201cbailout\u201d strategy for high-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors present the case of an adult patient with high-grade symptomatic carotid stenosis who was surgically managed with TCAR, requiring the adjunctive use of a DEP device due to insufficient flow reversal. The patient had a contralaterally occluded internal carotid artery, and poor retrograde flow was observed angiographically. The NAV6 Embolic Protection System was deployed through the transcarotid system. The case was successfully completed. There was no stroke perioperatively nor within 1 year postprocedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>For patients with poor flow reversal or isolated hemispheres during TCAR, adjunctive use of a DEP device may help mitigate the risks of distal embolization and periprocedural stroke.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25924\">https:\/\/thejns.org\/doi\/10.3171\/CASE25924<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25924","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:01:00Z","timestamp":1786492860000},"source":"Crossref","is-referenced-by-count":0,"title":["Use of distal embolic protection devices as a bailout strategy for suboptimal flow reversal during transcarotid artery revascularization: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2854-649X","authenticated-orcid":true,"given":"Andrew B.","family":"Koo","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2043-7205","authenticated-orcid":true,"given":"Sasha","family":"Stogniy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelaziz","family":"Amllay","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kshiraj V.","family":"Talati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4120-6649","authenticated-orcid":true,"given":"Daniela","family":"Renedo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7134-2273","authenticated-orcid":true,"given":"Joseph","family":"Haynes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Antonios","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanthiya","family":"Sujijantarat","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Hebert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles C.","family":"Matouk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Ann Vasc Surg Brief Rep Innov","first-page":"100272","article-title":"An evolution in carotid care: contemporary TCAR data and optimization techniques","volume":"4","author":"Nguyen","year":"2024","unstructured":"Nguyen TShames MBailey CJ.An evolution in carotid care: contemporary TCAR data and optimization techniques. Ann Vasc Surg Brief Rep Innov. 2024;4(2):100272. doi:10.1016\/j.avsurg.2024.100272"},{"issue":"5","key":"bib2","series-title":"J Vasc Surg","first-page":"1227","article-title":"Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal","volume":"62","author":"Kwolek","year":"2015","unstructured":"Kwolek CJJaff MRLeal JIResults of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. J Vasc Surg. 2015;62(5):1227-1234. doi:10.1016\/j.jvs.2015.04.460"},{"issue":"9","key":"bib3","series-title":"Stroke","first-page":"2620","article-title":"Early outcomes in the ROADSTER 2 study of transcarotid artery revascularization in patients with significant carotid artery disease","volume":"51","author":"Kashyap","year":"2020","unstructured":"Kashyap VSSchneider PAFoteh MEarly outcomes in the ROADSTER 2 study of transcarotid artery revascularization in patients with significant carotid artery disease. Stroke. 2020;51(9):2620-2629. doi:10.1161\/STROKEAHA.120.030550"},{"issue":"2","key":"bib4","series-title":"J Vasc Surg","first-page":"466","article-title":"One-year outcomes after transcarotid artery revascularization (TCAR) in the ROADSTER 2 trial","volume":"76","author":"Kashyap","year":"2022","unstructured":"Kashyap VSSo KLSchneider PAOne-year outcomes after transcarotid artery revascularization (TCAR) in the ROADSTER 2 trial. J Vasc Surg. 2022;76(2):466-473.e1. doi:10.1016\/j.jvs.2022.03.872"},{"issue":"1","key":"bib5","series-title":"J Vasc Surg","first-page":"92","article-title":"Transcarotid artery revascularization versus transfemoral carotid artery stenting in the Society for Vascular Surgery Vascular Quality Initiative","volume":"69","author":"Malas","year":"2019","unstructured":"Malas MBDakour-Aridi HWang GJTranscarotid artery revascularization versus transfemoral carotid artery stenting in the Society for Vascular Surgery Vascular Quality Initiative. 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J Vasc Surg. 2021;74(3):922-929. doi:10.1016\/j.jvs.2021.03.027"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/6\/article-CASE25924.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/6\/article-CASE25924.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/6\/article-CASE25924.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:01:00Z","timestamp":1786492860000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/6\/article-CASE25924.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":14,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/case25924","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}