Vertebral Artery Stenting at the Ostium of Left Vertebral Artery

- Operator : Hsien-Li Kao

Vertebral Artery Stenting at the Ostium of Left Vertebral Artery
- Operator: Paul Hsien-Li Kao, MD
Case Presentation
Three months ago, a 58-year-old man was admitted another hospital with syncope. Coronary CT showed significant stenosis at proximal to mid LAD and proximal RCA. In addition, brain CT/MR angiography showed severe stenosis in left vertebral artery ostium. One month ago, he was admitted our hospital with resting chest pain and received PCI at proximal to mid LAD (Endeavor Resolute 3.0x30mm and 3.5x26mm) and proximal RCA (Endeavor R 3.5x30mm). His coronary risk factors were hypertension, diabetes, hypercholesterolemia, and ex-smoking.
Baseline neck angiography
1. Brain CT angiography showed severe stenosis in left vertebral artery ostium.(Figure 1)
Procedure
A 7 Fr sheath was inserted into right femoral artery. Sequentially, left vertebral artery was engaged with 6 Fr JR4 diagnostic catheter with 0.032 terumo wire 260J and performed left vertebral angiogram. (Figure 2) After changing to 7 Fr JR4 guiding catheter, left vertebral artery was reengaged with 0.032 terumo wire 260J. For checking patient¡¯s condition, Dr. Kao frequently asked him to squeezing ball. A 0.014 inch 190cm FilterWire EZ was advanced cautiously and could pass the narrow stenotic lesion. (Figure 3) After then, Driver stent 4.0x18mm was advanced gently deployed exactly. (Figure 4) Post-dilation was performed with 4.0x18mm stent balloon upto 16atm. Finally, a 0.014 inch FilterWire EZ was removed. Final vertebral angiogram showed the perfect result. (Figure 5)

Comments

  • Ali Youssef 2011-06-03 Good case, Dr Kao; in your routine practice what are the indications for vertebral stenting ? Do you look at the cerebral circulation as a routine?
  • M Tarek Mounir Zaki 2011-06-03 DO YOU FEEL IT IS ABSOLUTELY NECESSARY TO DO THIS CASE USING A FILTER WIRE IF U HAVE TO DO IT AGAIN?
  • xiwei deng 2011-06-13 A filter wire isn't advanced cautiously always because vertebral artery is fine in asian. In our center, a 0.014inch wire passed lesion ,post- balloon and stent in most symptomatic vertebaral stenosed patient.

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