Elective Carotid Artery Stenting with Distal Protection Filter Device in Asymptomatic Patients
- Operator: John R. Laird, Jr, MD
Case Presentation
A 64-year old man was admitted for further evaluation of positive treadmill test. His cardiovascular risk factors were hypertension and smoking. He had no history of cerebrovascular accident. ECG showed LVH with strain pattern and echocardiographic findings were normal. Coronary angiogram revealed severe 3 vessel disease involving LM disease (Figure
1, Figure 2). His carotid Doppler showed a severe stenosis at right ICA (Figure 3, Figure 4) and MR brain angiogram revealed small lacunar infarction involving right corona radiata, severe stenosis at right proximal ICA and moderate stenosis at left ICA (Figure 5, Figure 6). He underwent coronary bypass surgery one month ago.
Preintervention Carotid and Cerebral Angiography
Preintervention carotid angiography revealed a tight stenosis of the right proximal ICA and a moderate stenosis of the left ICA that was consistent with MR angiographic finding (Figure 7, Figure 8). Preintervention right side cerebral angiogram showed slightly slow flow (Figure 9).
Procedure
Selective cannulation of the right common carotid artery (CCA) was performed using 5Fr Headhunter catheter, and a 0.035 inch stiff wire was inserted into the ECA (Figure 10). A 7Fr 90§¯ long shuttle sheath was positioned in the right CCA over the stiff wire. Then, a 0.014 inch Filterwire EZ was advanced beyond the critically stenotic lesion and the Filterwire was positioned in the distal ICA. The tight stenotic lesion was predilated with an Ultra-soft 4.0x20mm balloon to 6atm (4.0mm) for 4 seconds. Post-ballooning angiogram showed significant residual stenosis at right proximal ICA (Figure 11). A self-expanding, 10.0X20mm carotid Wallstent was positioned and implanted from the right CCA to the middle ICA (Figure 12). Post-stenting angiogram revealed a mild to moderate stenosis within the stented portion, and adjunctive balloon dilation was performed with an Ultra-soft 5.0x20mm balloon to 10atm (5.23mm) for 4 seconds. The final carotid and cerebral angiogram was very good (Figure 13, Figure 14). The patient had no periprocedural neurological deficit.
