Reverse flow enhancing catheterization of true lumen in carotid artery dissection: REFLECT technique
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Endovascular treatment of large vessel occlusion (LVO) caused by carotid artery dissection (CAD) is challenging due to difficulties in identifying and navigating the true lumen. Entering through the false lumen can complicate the procedure, increasing the risk of distal embolization into patent arteries (such as anterior cerebral artery) and making it harder to reach the LVO. We report a case of CAD leading to middle cerebral artery (MCA) occlusion, successfully managed with mechanical thrombectomy using a balloon guide catheter. Proximal flow arrest in the dissected carotid artery enabled flow reversal and facilitated the apposition of the false lumen, thereby enhancing visualization and navigability of the true lumen (REFLECT technique). Once the guiding catheter was positioned within the distal healthy segment of the carotid artery, it was possible to revascularize the intracranial arterial circulation. Subsequently, carotid stents were deployed within the true lumen to reconstruct the dissected carotid artery.
