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Serial Carotid Artery Stenting in left ICA 1 month after CAS in Rt ICA
- Operator: Seung-Whan Lee, MD
Clinical Information

- Relevant clinical history and physical exam:
A 70-year-old man who had stenting in right internal carotid artery 1 month ago admitted our hospital for intervention of left internal carotid artery. His risk factors were stroke (5 years ago), hypertension, Hyperlipidemia and smoking.

- Relevant angiography findings:
A carotid angiogram showed a significant stenosis in the Lt ICA with a “bird-beak” appearance.(Figure 1)

Interventional Management

- Procedural step:
We decided to treat more easier one with a concern of cerebral blood flow.
A 7 Fr sheath was inserted into right femoral artery. Right carotid artery was engaged with 5 Fr head hunter catheter. Carotid and cerebral angiograms was taken. After changing the sheath into a 7 Fr Cook Shuttle introducer sheath over a 0.035” stiff wire, a distal embolic protection device (Filter Wire EZ) was placed in the distal portion of Lt. ICA.(Figure 2) A 4.0 * 20 mm Ultra soft balloon was used to predilate the lesion and a self expandable 6.0 * 30 mm Acculink stent was deployed.(Figure 3, Figure 4) Adjunctive postdilatation was performed with a 5.0 * 20 mm Ultra Soft balloon at 10 atm.(Figure 5) All procedure was uneventful. Final carotid and cerebral angiogram showed improved blood flow with no residual diameter stenosis.(Figure 6, Movie 1, Movie 2)

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