Carotid Intervention with Embolic Protection Using the PercuSurge GuardWire

- Operator : Seong-Wook Park

Carotid Intervention with Embolic Protection Using the PercuSurge GuardWire
- Operator : Seong-Wook Park, MD
Clinical Information
A 60 year-old male with known three vessel coronary artery disease is being scheduled to undergo CABG one month later. He had an episode of embolic stroke three years ago. Neurologic deficit has been normalized. Preoperative Duplex Doppler study showed 85% stenosis of the left proximal internal carotid artery, which is composed of echodense plaque. Risk factor was a hypertension. Magnetic resonance angiography showed a moderate stenosis involving the left internal carotid artery and total occlusion of the left vertebral artery.
Pre-intervention carotid angiography
Pre-intervention carotid angiography revealed tight stenosis of proximal left internal carotid artery. Right internal carotid artery was normal. Reference vessel size and lesion length was 4.0 mm and 28 mm (Figure 1).
Interventional Procedure
A selective cannulation of left common carotid artery was performed using 5F Headhunter catheter. After cannulation, a 0.035" stiff wire was placed into external carotid artery. An 8Fr, 90-cm long shuttle sheath was positioned in the left common carotid artery over stiff wire. The Guardwire could be advanced beyond the second turn in the carotid artery (Figure 2). To reduce the time of balloon occlusion, predilatation balloon was positioned at the tip of shuttle sheath. And then, the occlusion balloon was inflated to 4.5-mm diameter. Predilatation was done with a 3.0 x 20 mm balloon at nominal pressure two times under distal protection. A self-expanding 7 mm x 40 mm carotid Wallstent was positioned and expanded from the left common carotid artery lesion to left internal carotid artery following predilation. Adjunctive balloon dilation was performed with a 4.0 mm x 20 mm balloon at 16 atm several times (Figure 3 and Figure 4). Following stenting, the embolic debris was aspirated using Export catheter. Large amount of atheroembolic debris was aspirated. Total distal balloon occlusion time was 420 seconds. The final result is shown in Figure 5. The patient had no neurological deficit and was discharged the following day.

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