Carotid Artery Stenting for Tight Left ICA Stenosis

- Operator : Hsien-Li Kao

Carotid Artery Stenting for Tight Left ICA Stenosis
- Operators: Paul Hsien-Li Kao, Young Hak Kim
Clinical presentation
A 56 year-old male was admitted due to effort-related chest pain for 2 years. He had hypertension and smoking as cardiovascular risk factor. He also had history of stroke 1 year ago. Echocardiography revealed preserved LV contractility (LVEF=60%) without definite regional wall motion abnormality. About 4 weeks ago, he received PCI at distal LM to proximal LAD with Cypher 3.5 X 33mm stent. At that time, his carotid angiogram showed 80% narrowing of Lt ICA. Carotid duplex sonography showed 70-79% stenosis(PSV 317cm/s) and turbulence of Lt carotid bulb with isoechoic & calcified plaque.
Baseline coronary angiogram

1. Left carotid angiogram revealed very tight stenosis from bulb to proximal ICA with hypoplastic vertebral artery(Figure 1, Figure 2).
2. Left cerebral angiogram showed obstructed anterior communicating artery(Figure 3, Figure 4).
3. Right carotid angiogram revealed relatively mild luminal narrowing.

Procedure
A 8 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(see above). 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 (Figure 5). After then, the Self expandable PT wall stent 9.0 X 30mm was advanced gently and deployed (Figure 6, Figure 7). After verifying optimal position of stent, post-dilation was performed with Ultra soft 5.0 X 20mm up to 6atm (Figure 8). And then we aspirated debris from distal Lt ICA with 6 Fr Export aspiration catheter. Afterthere we removed 0.014 inch Filter Wire EZ. Final carotid angiogram showed good result with 10% residual diameter stenosis (Figure 9). Final cerebral angiogram showed brisk and much improved cerebral blood flow.
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