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Catheter looping and retrograde engagement technique.
(CLARET) — a novel method for carotid stenting The use of CLARET for cerebral angiographic study is a novel technique which was first introduced by the authors in 2005 [102], and technical refinement for carotid stenting was reported in 2006 [103] and in 2010 [104]. The procedural success rate by CLARET for carotid stenting was reported to be greater than 98.5% [103,104] and the risk of procedure-related IS rate was less than 3.0%, which was comparable with other studies [43–45,93,94]. Between January 2004 and June 2015, CAS by either TRA or TBA was performed in 450 cases at our hospital (Table 3). Among them, the first 98 patients did not receive the Filter wire for distal protection due to unavailability in the hospital. The mean age was 70 ± 9.3 years and 81.6% were male gender. The procedural success was 99.1% (446 / 450). In four patients the TRA was unsuccessful due to severe aortic regurgitation in one case, and very tortuosity aortic root and aortic arch in the other three cases. The procedure related IS rate was 4.7% (21 / 450). Of these 21 patients, 4 patients who experienced acute IS within 7 days prior to the procedure, and in 8 patients the Filter wire for distal protection was not used due to unavailability (i.e., they were the first 98 cases). Of these patients, two patients were dead due to sepsis and multiple organ failure during hospitalization. The other patients were finally discharged from hospital and being regularly followed-up at the outpatient department. To date, CLARET is routinely used in our hospital that mastered mature transradial intervention techniques. To ensure a successful CLARET technique of carotid stenting, the following essential steps are essential [102–104](Table 4):
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