Carotid Artery Stenting in left internal carotid artery stenosis

- Operator : John R. Laird

Carotid Artery Stenting in left internal carotid artery stenosis
- Operator: John, R Laird Jr, MD
Clinical Information

- Relevant clinical history and physical exam:
A 55-year-old man was presented outside hospital with NSTEMI one month ago and referred for CABG due to failed PCI. Preoperative evaluation revealed severe stenosis of Lt. carotid artery on MR angiography. He underwent CABG first without an event and was readmitted for a treatment of Lt carotid artery stenosis. He had a history of hypertension, hyperlipidemia, and ex-smoking.

- Relevant test results prior to catheterization:
A MR angiogram showed a significant stenosis of Lt ICA

- Relevant angiography findings:
A Carotid angiogram showed significant stenosis in the Lt ICA.(Figure 1)

Interventional Management

- Procedural step:
A 6 Fr sheath was inserted into right femoral artery. Left carotid artery was engaged with 5 Fr head hunter catheter and carotid and cerebral angiograms were taken.( Movie 1) 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. A 4.0 * 20 mm Ultra soft balloon was used to predilate the lesion and a self expandable 7.0 * 30 mm SMART CONTROL stent was deployed.(Figure 2) Adjunctive postdilatation was performed with a 5.0 * 20 mm Ultra Soft balloon at 14 atm. All procedure was uneventful. Final carotid angiogram showed good result with no residual diameter stenosis and final cerebral angiogram showed brisk and much improved cerebral blood flow.(Figure 3, Movie 2)

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