Slides Endovascular Carotid
Stroke preventive bilateral carotid artery stenting before coronary bypass surgery
- Operator : Daniela Cerná
Stroke preventive bilateral carotid artery stenting before coronary bypass surgery |
- Operator: Daniela Cerná, MD |
Clinical Information |
- Relevant clinical history and physical
examination: - Relevant test results prior to catheterization: - Relevant catheterization findings: |
Interventional Management |
- Procedural step: It was decided to treat the coronary heart disease surgically - patient was accepted for CABG. Because of high periprocedural risk of stroke and chronic nature of ischemic heart disease, it was possible postpone surgery for a month and provide bilateral carotid artery stenting (CAS). At first, CAS of RICA was performed using an Amplatz Right guiding catheter 8F (Boston Scientific, Natic, MA) and Filter Wire (Boston Scientific, Natic, MA) protection system (Figure 9). We implanted 6-9mm x 40mm Sinus stent (Optimed Medizinische Instrumente GmbH, Ettlingen, Germany) without predilation (Figure 10, Figure 11) and the stent was postdilated by 6mm x 20mm Ultrasoft baloon (Boston Scientific, Natic, MA) without residual stenosis (Figure 12, Figure 13). Then CAS of LICA was performed during the same procedure. Vitek catheter 5 Fr (Cook Inc., Bloomington, IN, USA) was used for diagnostic angiography and then using telescopic technique (and Vitek diagnostic catheter) was a long sheath (6 Fr) advanced into common carotid artery. Filter Wire (Boston Scientific, Natic, MA) embolic protection system was used as well. Subsequently 6-8mm x 40 mm Xact stent ( Abbott Lab., Abbott Park, IL, USA) was deployed directly without residual stenosis and didn¢¥t required postdilation (Figure 14, Figure 15). After the postdilation of the first stent patient was hypotensive and the 500 ml infusion solution and dopamine 200mg was administered with effect, so procedure didn¡¯t have to be interrupted. Besides procedure was uneventful, without neurologic complications. Patient recovered well and successfully underwent CABG surgery after the one month of dual antiplatelet therapy with clopidogrel and aspirin. Peripheral artery disease is planed to be investigated in the next period. Though there are still sufficient data missing, in certain cases (e.g. before CABG) it is possible proceed safely bilateral CAS during one operation. |
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