- Relevant clinical history and physical exam:
A 70-year-old man was presented outside hospital with facial edema and was diagnosed as carotid artery stenosis. He was referred for carotid artery intervention. He had a history of stroke, 5 years ago, hypertension, hyperlipidemia, and a habit of smoking.

- Relevant test results prior to catheterization:
A MR angiogram showed significant stenosis of both ICA and multifocal moderate stenosis in the left SCA.

- Relevant angiography findings:
A carotid angiogram showed a significant stenosis in the Rt ICA and a very severe stenosis in the Lt ICA with a “bird-beak” appearance.(Figure 1, Figure 2)

- 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. Left carotid artery was engaged with 5 Fr head hunter catheter and carotid 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 Rt. ICA.(Figure 3) A 3.5 * 20 mm Maverick balloon was used to predilate the lesion and a self expandable 8.0 * 24 mm SMART CONTROL stent was deployed. Adjunctive postdilatation was performed with a 5.0 * 20 mm Ultra Soft balloon at 6 atm.( Movie 1) All procedure was uneventful. Final carotid and cerebral angiogram showed good result with no residual diameter stenosis.( Movie 2)