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Carotid Artery Stenting Using Proximal Embolic Protection System in Right 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 complained of recent intermittent headache and dizziness. His cardiovascular risk factors were diabetes, hypertension, dyslipidemia and smoking. A magnetic resonance angiography showed significant stenosis at the right internal carotid artery (ICA).
Baseline Imaging Studies
1. Magnetic resonance angiography revealed a severe stenosis at the right proximal ICA (Figure 1).
2. Carotid angiography showed a significant stenosis (Figure 2).
Endovascular Procedure
The right femoral artery was punctured and a 9 Fr sheath was introduced. After insertion of a 5 Fr Headhunter diagnostic catheter into the right common carotid artery (CCA), we performed carotid angiography ( Movie 1). After introducing the diagnostic catheter into the right external carotid artery (ECA), 0.035 stiff guidewire was inserted and the diagnostic catheter was removed (Figure 3, Figure 4). Thereafter, the MoMa Ultra embolic protection system was introduced from right CCA to right ECA (Figure 5) to prevent fatal distal embolization during the intervention. The balloon in distal ECA and CCA was sequentially inflated which suspends the antegrade blood flow from CCA and retrograde blood flow from ECA (Figure 6). The Neo’s sion 0.014 wire was introduced to Rt. ICA and predilatation for lesion modification was done using a Sterling 4.0 x 20mm balloon. Self-expandable RX Acculink carotid stent was carefully deployed and additional stent dilatation using Aviator 5.0 x 20mm balloon was sequentially performed (Figure 7, Figure 8). Finally, emboli suction was done through the MoMa Ultra system and the final carotid angiogram showed successful result with no residual diameter stenosis ( Movie 2).
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