Background: Carotid artery stenting (CAS) could lead to a modification of the carotid bifurcation geometry with possible clinical implications. This study aimed to clarify the geometrical impact of three carotid stents with different designs on the carotid bifurcation and its clinical consequences. Methods: This was a retrospective single-center study. We included all patients who underwent CAS in a 3-year period. Anatomical changes of the carotid bifurcation were evaluated by reviewing angiographic images. The population was divided into three groups based on the stent implanted: Group 1 (Carotid Wallstent), Group 2 (Roadsaver), and Group 3 (C-Guard). Results: A total of 226 patients were included. The mean age was 77.0 ± 7.4 years and 72.5% (164/226) were male. Three different stents were implanted into three groups: Group 1 (n = 131/226, 58%), Group 2 (n = 57/226, 25.2%), and Group 3 (n = 38/226, 16.8%). The mean pre-stent implantation CCA-ICA angle of the entire population was 155 ± 14.9°, and the post-CAS angle was 167.7 ± 8.7° (p = 0.0001). In every subgroup, the difference was statistically different, with the biggest difference registered in Group 2 (−16.1 ± 13.2°). Regarding stent oversizing, there was a significant relationship between CCA oversizing and CCA-ICA angle modification (p = 0.006). During follow-up, a total of 14 (6.2%) restenoses were registered. The mean CCA-ICA angle modification in the restenosis group was −9.5 ± 14.4° vs. −12.8 ± 11.9° in the no-restenosis group with no significant statistical differences were outlined (p = 0.3). Conclusions: Compared to the Carotid Wallstent and C-Guard, the Roadsaver stent appears to have a lower adaptability to the carotid vascular territory, resulting in a higher CCA-ICA angle modification after implantation, with no impact on the stent restenosis rate.

Purpose: To describe the ECO-PLUG technique, a standardised ultrasound-guided workflow for percutaneous femoral access and plug-based closure, and to report its feasibility and clinical performance in patients undergoing peripheral artery revascularization procedures. Technique: The ECO-PLUG protocol incorporates continuous ultrasound guidance throughout all procedural phases: femoral access, closure device deployment, and post-procedural haemostasis verification. Five predefined checkpoints (C1-C5) structure the workflow from pre-access mapping to early and delayed ultrasound follow-up. Key elements include in-plane puncture, ultrasound-guided plug deployment with a modified retract manoeuvre, and systematic colour-Doppler assessment at 0 and 3 to 5 minutes after closure. Results: A total of 200 elective endovascular procedures using 6F/8F femoral access were analysed. Anatomical complexity was common, including moderate-to-severe anterior wall calcification (55%), arterial depth >35 mm (24%), and bifurcation variants (22%). Immediate haemostasis was achieved in 98% of cases, while 2% required prolonged compression or manual conversion. Access-related complications occurred in 4% of patients, including pseudoaneurysms (1.5%) and haematomas. No arterial occlusions or surgical conversions were observed. Conclusions: The ECO-PLUG protocol demonstrates acceptable haemostasis efficacy and a favourable access-site safety profile across anatomically complex settings, supporting its potential as a structured image-guided closure strategy. Prospective comparative studies are needed to validate these preliminary findings. Clinical Impact: The ECO-PLUG protocol introduces the first formally structured, checkpoint-based ultrasound workflow integrating continuous imaging guidance across all phases of percutaneous femoral closure, from pre-access mapping through plug deployment and hemostasis verification. Unlike conventional approaches, where ultrasound use is typically limited to arterial puncture alone, ECO-PLUG extends real-time sonographic control to anchor positioning and collagen release, reducing operator dependency in anatomically complex cases. With 98% immediate hemostasis and no arterial occlusions or surgical conversions across 200 consecutive procedures, including patients with heavy calcification, deep vessels, and bifurcation variants, this protocol offers clinicians a reproducible, teachable standard applicable across varying experience levels.

The detachment of components of endovascular devices is a rare but potentially harmful complication. This report describes a clinical case of nosecone detachment from an iliac branch device delivery system during an aortoiliac aneurysm exclusion in a 73-year-old male patient. After correct deployment, the iliac branch device nosecone detached during the removal of the delivery system. The guidewire was snared from the contralateral side, and two long sheaths were advanced to trap and protect the fractured piece, ensuring nice alignment and enabling its safe removal. This case highlights key strategies for managing serious complications encountered during endovascular aortic repair.

Background: In a significant proportion of carotid interventions, carotid graft replacement is required to achieve a successful outcome either as a primary method or as a bailout solution. Whether carotid grafting should be performed, the indications for its use, and other technical aspects remain insufficiently addressed in the literature. An exhaustive mapping of the sparse and heterogeneous evidence available in the literature may provide a more comprehensive understanding of this topic. Objective: This scoping review aims to examine and summarize the scientific evidence on the indications, graft types, and outcomes of graft interposition during elective and emergency carotid interventions. Methods: This scoping review will be conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines for reporting. Peer-reviewed papers written in English will be identified through searches of the following databases: PubMed (MEDLINE), Embase, Scopus, and Web of Science. The web-based systematic review platform Rayyan will be used for deduplication and study screening. The review will encompass the following clinical scenarios: elective carotid endarterectomy, emergent carotid endarterectomy, carotid artery restenosis, carotid artery trauma, carotid artery aneurysm, carotid artery dissection, carotid patch infection, radiation-induced carotid fibrosis, and carotid body tumors. All study designs (randomized controlled trials, observational studies, and case series) will be considered. Non-English studies, animal studies, cadaveric or anatomical-only reports, and purely technical notes without clinical data will be excluded. Data regarding extracranial-to-intracranial bypass will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage), and data extraction (third stage) will be performed by a group of researchers, whereby each paper will be reviewed by at least 2 researchers. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be resolved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. Data synthesis will be performed with the aim of clearly presenting the indications, graft types, and outcomes of graft interposition during carotid interventions. Results: The search strategy was finalized in July 2026. Preliminary searches of PubMed (MEDLINE), PROSPERO, and JBI Evidence Synthesis databases identified no published or registered systematic or scoping reviews specifically addressing carotid interposition grafting across elective and emergent carotid interventions. As of September 2026, formal database searches and study selection had not yet begun and were scheduled to start in October 2026. Data extraction and evidence synthesis are expected to be completed by spring 2027, and submission of the final scoping review is planned for summer 2027. Conclusions: Our scoping review will seek to provide an overview of the available evidence and identify research gaps regarding the role of graft interposition during elective and emergent carotid interventions.