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Video credit – Christian Vuolo – Synaps

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Case presentation: 


Clinical Data:

  • Man, 58 years, past smoking,
  • 2011, september: ischemic stroke (right capsulo-lenticular location)
  • Silent myocardial infarction, with a large inferior sequelae
  • severe PAOD: infrarenal abdominal aorta occlusion, renal arteries stenosis, left subclavian artery occlusion 
  • 2011, september: recanalization and stenting of the left subclavian artery

Learning objectives:

  • How to approach carotid arteries in case of severe abdominal aorta or ilio-femoral arteries disease?
  • how to stage and how to schedule patients in case of multiple lesions?
  • What are solutions for embolic distal protection and how to choose between the different devices available?
  • Is there a place for IVUS and OCT in carotid artery stenting?


Procedural steps:

1. access: 

  • Right radial access, 6F, 10 cm Radiofocus, Terumo
  • Canulation of the Right Common Carotid Artery with an angiographic catheter 5F, 100 cm, SIM 2 Super Torque, Cordis, advanced upon a 0,035" Radiofocus Terumo angled stiff guidewire M-type, 260 cm
  • Exchange guidewire to with a 0,035" - 260 cm, Glidewire Advantage, Terumo
  • Failure to advance the shuttle upon the Advantage Glidewire
  • Repositioning of the SIM 2 Super Torque, Cordis, to position a 0,035" - 260 cm Extra Stiff Wire Guide, 0,035", Amplatz, Cook  in the right common carotide artery
  • Advance a 6F - 90 cm shuttle, Flexor, Cook, upon the Amplatz guidewire

2. Distal protection device placement

  • Anchoring of the shuttle with a V18 guidewire, Boston Scientific, placed in the external carotid artery
  • Deploiement of a 7,2 x 23 mm Emboshield NAV system, Abbott, distal to the lesion

3. Performance of an OCT imaging:

4. Stenting and postdilation:

  • Retrieval of the V18 guidewire 
  • Deploiement of a Carotid stent System 7 - 9 x 30 mm Xact, Abbott
  • Postdilation with a 5 x 20 mm Ultra Soft SV balloon, Boston Scientific

5. Control of the result by OCT

6. Retrieval of the Emboshield System




Shooting date : 2011-12-01
Last update : 2021-06-09
Max Amor
Essey-lès-Nancy, France

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