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Case series
The modified ‘no touch’ technique in the antegrade endovascular approach for left common carotid artery ostial stenosis stenting
  1. Xiaobin Tang1,
  2. Whitney Annie Long2,
  3. Chang Hu3,
  4. Feng Tang3,
  5. Qian Wang3,
  6. Lei Li3
    1. 1Vascular Surgery Department, Capital Medical University Affiliated Anzhen Hospital, Beijing, China
    2. 2Tsinghua University Medical Center, Beijing, China
    3. 3Vascular Department, Beijng Huaxin Hospital First Hospital of Tsinghua University, Beijing, China
    1. Correspondence to Professor Dr Lei Li, Vascular Department of Beijng Huaxin Hospital First Hospital of Tsinghua University, Beijing, China; dr.lilei{at}


    Background Open surgery and the retrograde endovascular approach via the distal left common carotid artery (LCCA) have some limitations in LCCA ostial stenosis treatment. The ‘no touch’ technique used in the renal artery was modified for this situation.

    Methods Fifteen selective LCCA stenosis patients were treated by the modified ‘no touch’ technique in the antegrade endovascular approach from March 2013 to March 2016. Thirteen underwent the transfemoral approach and the other two had the transbrachial approach due to a ‘bovine aortic arch’. Distal embolic protection devices were used in all cases. Follow-up included a neurological examination, carotid duplex scan, and office interview. Mean follow-up time was 18.2±11.5 months.

    Results The initial technical success rate was 100%. The average procedure time was 84.0±16.3 min. There were no procedure-related deaths. No clinical neurological complications occurred during the in-hospital stay. No incidence of death or major stroke occurred during the follow-up period; 6.7% (1/15) of patients had a contralateral minor stroke, 66.7% (4/6) of symptomatic patients were relieved of initial symptoms, and the rest showed improvement. No patient developed new ipsilateral neurological symptoms and no in-stent restenosis occurred during the follow-up period. These results were confirmed by ultrasound.

    Conclusions The modified ‘no touch’ antegrade endovascular technique is a feasible method for treating LCCA ostial lesions with a satisfactory initial success rate, acceptable procedure time, and comparable mid- and long-term results. This technique could be considered as a complementary option for LCCA ostial stenosis in addition to open surgery and the retrograde endovascular approach.

    • Cervical
    • Stenosis
    • Stroke
    • Technique
    • Stent
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    • XT and WAL are joint first authors.

    • Collaborators Ju Qiu and Xiaoyan Sun were the nurses in the study.

    • Contributors LL led the study, XT designed the study, WAL analyzed all the data and wrote the article, FT, CH and QW played an important role in the procedures and data collection.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ethics approval was obtained from the institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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