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Left Internal Carotid Artery Occlusion with Progressive Right Internal Carotid Artery Stenosis


This 18 minutes didactic recorded procedure concerns a 68 years male with coronary insufficiency and carotid lesions. He presents an occluded left internal carotid artery associated with a severe ulcerated worsening right internal carotid stenosis.
This complex stenosis was treated by new micromesh carotid stent under carotid protection by filter . Watch this informative procedure on how to treat patients with multiple carotid lesions.

Step-by-Step Procedure

  • Femoral access for carotid angioplasty
  • Common carotid access in tortuous aorta
  • Analysis of carotid lesion by selective angiography
  • Placement of filter as embolic protecting device
  • Pre-dilatation and artery preparation before carotid artery stenting
  • Placement of braided micromesh stent Roadsaver
  • Post Stenting dilatation and analysis of results
  • Filter retrieval and evaluation of carotid circulation  

Learning points

  • How to access from groin the brachio-cephalic trunk in a tortuous aorta
  • The use of two guidewires to access common carotid
  • Placement of filter in a tortuous carotid artery
  • Predilatation and preparation of carotid lesion before stenting
  • Accurate placement of new micromesh carotid stent
  • Cardiac monitoring during carotid stenting

Bibliography

 

Shooting date : 2017-09-28
Last update : 2021-05-11
Max Amor
Essey-lès-Nancy, France

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  • arie B. 'ישא 'שד איק ןמגןבשאןםמ שדטצפאםצשאןב פשאןקמא 'ןאי ךקדד איקמ 50% דאקמםדןד?.

    • Max A. dont understand . Sorry

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  • AWADHESH D. Nice

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  • Zambonialbe A. Very interesting case !

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    • Alexander P. super

      • Max A. Thank you

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    • Chun-Yuan C. Will direct stenting be another choice ?

      • Max A. Sorry for the delay .
        I recommend to predilate for this micromesh Stent to be sure to have an harmonious deployment to easen the crossing . It is particularly important with the CGuard stent

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    • Milan M. Nice example! According to your experience, how do the Micromash Stents behave in highly calcified lesions? Thank You

      • Max A. In very calcified lesions it is indispensable to prepare the lesion by a pre-dilatation in order to be sure that the residual stenosis is not Severe .

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    • Mohammed R. Good

      • Max A. Thank You

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    • Maher J. Perfect job

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      • Maher J. Nice job

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