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Carotid Artery Stenting in Left Internal Carotid Artery
- Operator: Seung-Whan Lee, MD
Case Presentation
A 75 year-old man was referred for the treatment of carotid artery stenosis. He visited our neurology center complaining of dizziness and syncope induced by sudden positional change for one year. He had a past medical history of three vessel disease treated by CABG about 2 years ago. Carotid duplex sonography and magnetic resonance angiography showed significant stenosis at the left proximal internal carotid artery.
Baseline Imaging Studies
1. Carotid duplex sonography showed a significant stenosis (diameter reduction; 74%, velocity criteria; 80-95%) with irregular calcified hypoechoic plaque in left carotid bulb to proximal internal carotid artery and increased peak systolic velocity (503.3 cm/sec) (Figure 1).
2. Magnetic resonance angiography revealed a significant stenosis at the left proximal internal carotid artery (Figure 2).
3. Carotid angiography showed a significant stenosis with luminal irregularity (Figure 3).
Endovascular Procedure
The right femoral artery was punctured and a 7 Fr sheath was introduced. After insertion of a 5 Fr Headhunter diagnostic catheter into the left common carotid artery, we performed carotid and cerebral angiography ( Movie 1, Movie 2). The diagnostic catheter was exchanged to the 7Fr Shuttle guiding catheter and the tip of the catheter was positioned proximal of the left common carotid artery ( Movie 3). Then, we inserted the FilterWire EZ (embolic protection system) 0.014 inch 150 cm into the left internal carotid artery to prevent fatal distal embolization during the intervention. Next, pre-ballooning with an Aviator 5.0 x 20 mm sized balloon was performed at the left internal carotid artery. And then, a 7.0~10.0 x 30 mm sized self-expandable Rx Acculink carotid stent was deployed ( Movie 4). Adjunctive post-stenting balloon dilation was not performed. All procedure was uneventful. Final carotid angiogram showed good result with no residual diameter stenosis ( Movie 5).
Arash Gholoobi2012-11-05
I beleive direct stenting with postdilation would be a better strategy.
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