Carotid Artery Stenting in Right ICA with Symptomatic Patient

- Operator : John R. Laird

Carotid Artery Stenting in Right ICA with Symptomatic Patient
- Operator: John R. Laird, MD
Relevant clinical history and physical exam
A 66 year-old man was admitted our hospital for the intervention of right internal carotid artery. He had past medical history of AMI (1997) and stenting at left subclavian artery (2008). His vascular risk factors were hypertension, diabetes and smoking. A brain MR angiogram showed a significant focal stenosis at right proximal ICA. He refused vascular operation
Relevant test results prior to catheterization
Echocardiogram showed moderate LV dysfunction with multiple regional wall motion abnormalities.
Relevant angiography findings
The pre-intervention angiography showed severe restenosis of right ICA(Figure 1). Preintervention right side cerebral angiogram showed slightly slow flow( Movie 1).
Procedure
A 5 Fr sheath was inserted into right femoral artery. Sequentially, right carotid was engaged with 5 Fr head hunter catheter and performed right carotid angiogram. A 6Fr 90§¯ long shuttle sheath was positioned in the right CCA over the stiff wire. Then, a 0.014 inch Filterwire EZ was advanced beyond the critically stenotic lesion and the Filterwire was positioned in the distal ICA. The tight stenotic lesion was predilated with an Aviator 4.0 X 30 mm balloon to 6atm( Movie 2). A self-expanding, RX Acculink stent 6-8 X 40 mm was positioned and implanted from the right CCA to the middle ICA. Post-stenting angiogram revealed a mild to moderate stenosis within the stented portion, and adjunctive balloon dilation was performed with an Aviator 5.0 X 20 mm balloon to 12atm. The final carotid and cerebral angiogram was very good( Movie 3). The patient had no periprocedural neurological deficit.

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