Introduction and purpose To assess the feasibility and safety of carotid revascularization in subacute conditions, using a flow reversal system.

Materials and method A total of five patients presenting with subacute carotid occlusion and non-disabling neurologic deficits underwent endovascular revascularization of their occluded vessel by using a flow reversal system as a protection device against embolic phenomena. In two cases, in addition to the flow reversal system a protective filter has been added on prior to completion of revascularization. All patients underwent the intervention under general anesthesia. After revascularization, all patients underwent placement of stents at the locations presumed responsible for their occlusions. All patients were managed immediately in the neurointensive care unit under strict blood pressure control.

Results Technically, all of the procedures were successful with no embolic phenomena. In patients where a filter device was used in addition to the flow reversal system, the filter was inspected visually after removal and no clots or debris were identified.

There were no neurological deficits associated with the procedure. There were no systemic or local complications associated.

In one patient a 6 month clinic and angiographic follow-up was obtained. This demonstrated patency of the stent. The patient did not develop any additional neurological deficits.

Conclusion Preliminary results of using a flow reversal system in carotid artery subacute revascularization suggest that this technique is feasible and effective. A larger patient cohort would be necessary to further address the safety of the procedure, indications and long term results.