Slides
Elective Carotid Artery Stenting in Patients with Severe Coronary Artery Disease and Severe LV Dysfunction
- Operator : John R. Laird
| Elective Carotid Artery Stenting in Patients with Severe Coronary Artery Disease and Severe LV Dysfunction |
| - Operator : John R. Laird, MD |
| Clinical information |
| A 74 year-old male with known three vessel coronary artery disease was scheduled for CABG one month later. Echocardiography revealed severe LV dysfunction (LVEF=30%) without regional wall motion abnormality. Risk factors included hypertension and 60 pack years of smoking. He had had an episode of embolic stroke one year previously, with dysarthria remaining as a neurologic deficit. Preoperative Duplex Doppler study showed 80% calcific stenosis of the right proximal internal carotid artery, which was composed of echodense plaque. Vascular surgeons were reluctant to perform carotid endarterectomy on this patient, because of a possible intraoperative or perioperative myocardial infarction. |
| Pre-intervention carotid angiography |
| Pre-intervention carotid angiography revealed tight stenosis of the proximal right internal carotid artery. The left internal carotid artery was normal. (Figure 1). |
| Interventional procedure |
| Selective cannulation of the right common carotid artery was performed using a 5F Headhunter catheter. After cannulation, 0.035 stiff wire was inserted into the external carotid artery. An 8F, 90-cm long, shuttle sheath was positioned in the right common carotid artery over the stiff wire. The Percusurge Guardwire was advanced beyond the right distal internal carotid artery, then inflated to 4.5-mm diameter (Figure 2). Predilatation was done twice with a 3.0 x 20 mm balloon at nominal pressure under distal protection (Figure 3). Predilatation was done twice with a 3.0 x 20 mm balloon at nominal pressure under distal protection (Figure 4). After predilatation, a self-expanding, 9mm x 30mm, carotid Wallstent was positioned and expanded from the right common carotid artery lesion to the internal carotid artery (Figure 5). Adjunctive balloon dilation was performed several times with a 5.0mm x 20mm balloon at 12 atm. Following stenting, the embolic debris was aspirated using an Export catheter. A large amount of atheroembolic debris was aspirated. The final result is shown in Figure 5. The patient had no neurological deficit and was discharged two days later without event. |
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