Carotid Artery Stenting for Tight Left ICA Stenosis

- Operator : Dierk Scheinert

Carotid Artery Stenting for Tight Left ICA Stenosis
- Operators: Dierk Scheinert, MD, Seung Hyuk Choi, MD
Clinical presentation

A 61 year-old male was admitted due to effort-related chest pain and claudication. The diagnostic coronary angiogram showed three vessel disease. Therefore he planned to undergoing CABG and check the MRA. The MRA revealed severe stenosis with ulcerateion in left proximal ICA. He underwent carotid angiography. The carotid angiography revealed tight stenosis in left ICA as well. Carotid duplex sono showed echogenic plaque with small calcification in left middle CCA and ulcerated hypoechoic plaque with calcification from bulb to proximal in left ICA. He had a history of hypertension, dyslipidemia but without a history of stroke. or 2 years. He had hypertension and smoking as cardiovascular risk factor. The echocardiography showed normal LV systolic function without wall motion abnormality.

Baseline coronary angiogram

1. Left carotid angiogram revealed very tight stenosis in proximal ICA(Figure 1).
2. Left cerebral angiogram showed obstructed anterior communicating artery(Figure 2).
3. Right carotid angiogram revealed relatively mild luminal narrowing.

Procedure
A 7 Fr sheath was inserted into right femoral artery. Sequentially, right and left carotid was engaged with 6 Fr JR catheter with 4.0cm curve and performed bilateral carotid angiogram(Figure ). Initially, left carotid was reengaged with 8 Fr JR guiding catheter with 4.0cm curve. For the protection of distal embolization, 0.014 inch Filter Wire EZ was advanced cautiously and distally located. After then, predilation was performed with 4.0 X 20 Amiia(powerflex) ballon. Self expandable precise Rx(Smart control) 9.0 X 40 mm was advanced gently and deployed. After verifying optimal position of stent, post-dilation was performed with 6.0 X 20 Amiia (Powerflex) balloon. Afterthere we removed 0.014 inch Filter Wire EZ. Final carotid angiogram showed good result with no residual diameter stenosis (Figure 3). Final cerebral angiogram showed brisk and much improved cerebral blood flow(Figure 4)

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