Slides Endovascular Carotid
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). |
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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