Carotid Artery Stenting for Right ICA Stenosis

- Operator : John R. Laird

Carotid Artery Stenting for Right ICA Stenosis
- Operators: John R. Laird Jr, MD, Seung-whan Lee, MD
Clinical presentation

A 73 year-old male was admitted due to Left side weakness. The Brain Diamox SPECT showed multifocally decreased perfusion of Rt.MCA terrritory. He has adiabetes, hypertension, and dyslipidemia

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.
3. Right carotid angiogram revealed relatively mild luminal narrowing.

Procedure

A 6 Fr sheath was inserted into right femoral artery. Sequentially, right and left carotid was engaged with 5 Fr head hunter catheter and performed bilateral carotid angiogram(Figure 1). Initially, right carotid was reengaged with VTK 5Fr guiding catheter, and a 0.032" terumo wire was inserted into the ECA. A 7Fr shuttle sheath was positioned in the right CCA over the 0.032" terumo wire. For the protection of distal embolization, 0.014 inch Filter Wire Angio Guard Rx (Embolic protection system) was advanced cautiously and distally located. After then, predilation was performed with 4.0 X 30 Amiia(powerflex) balloon. Self expandable precise Rx(Smart control) 8.0 X 30 mm was advanced gently and deployed. After verifying optimal position of stent, post-dilation was performed with 5.0 X 20 Ultra soft balloon. After that, we removed 0.014 inch Filter Wire EZ. Final carotid angiogram showed good result with no residual diameter stenosis (Figure 2). Final cerebral angiogram showed brisk and much improved cerebral blood flow (Figure 3).

Leave a comment

Sign in to leave a comment.