Carotid Artery Stenting Using Embolic Protection System in Left Internal Carotid Artery Stenosis

- Operator : Seung-Whan Lee

Carotid Artery Stenting Using Embolic Protection System in Left Internal Carotid Artery Stenosis

- Operator: Seung-Whan Lee, MD

Case Presentation

A 69 year-old male was referred for the treatment of carotid artery stenosis. He has had no specific neurologic symptoms. A carotid artery stenosis was revealed on health screenings at another hospital with a carotid duplex sonography. His cardiovascular risk factors were hypertension, dyslipidemia and previous percutaneous coronary intervention. A magnetic resonance angiography showed significant stenosis at the left internal carotid artery.

Baseline Imaging Studies

1. Magnetic resonance angiography revealed a severe stenosis at the left proximal internal carotid artery (Figure 1). 2. Carotid angiography showed a significant stenosis (Figure 2).

Endovascular Procedure

The right femoral artery was punctured and a 6 Fr sheath was introduced. After insertion of a 5 Fr Headhunter diagnostic catheter into the left common carotid artery, we performed carotid angiography ( Movie 1). We exchanged a 6 Fr sheath for an 8 Fr Flexor Shuttle guiding sheath and the tip of the sheath was positioned proximal to the left common carotid artery ( Movie 2). Then, we inserted the FilterWire EZ (embolic protection system) into the left internal carotid artery to prevent fatal distal embolization during the intervention. After that, predilatation was done using a 4.0 x 20 mm Sterling SL balloon at the left internal carotid artery. Next, a 7.0 x 10 mm self expandable RX Acculink stent was deployed ( Movie 3, Movie 4). Additional ballooning was performed using 4.0 x 20 mm Sterling SL balloon in stent. Final carotid angiogram showed successful result with no residual diameter stenosis ( Movie 5, Movie 6).