It looks like you're using an obsolete version of internet explorer. Internet explorer is no longer supported by Microsoft since the end of 2015. We invite you to use a newer browser such as Firefox, Google Chrome or Microsoft Edge.
My Player placeholder

Become an Incathlab member and receive full access to its content!

You must be an Incathlab member to access videos without any restrictions. Register for free in one minute and access all services provided by Incathlab.You will also be able to log into Incathlab from your Facebook or twitter account by clicking on login on the top-right corner of Incathlab website.

Registration Login


This didactic procedure concerns a 70 years old man presenting with asymptomatic severe calcified and ulcerated left internal carotid on echography. Angiography revealed a severe ulcerated stenosis of the left internal carotid artery.

Educational objectives

  • Plan a step-by-step carotid artery stenting procedure.
  • 48 hours of dual antiplatelet therapy before the procedure;
  • Interruption of anti-hypertensive therapy the day before
  • How to manage access through tortuous anatomy?
  • Materials choice: guidewires, protection filter, guiding catheter, balloons and carotid stent.
  • How to prepare, advance the embolic protection system: FilterWire EZ™ through the lesion and release the filter upstream the lesion?
  • Tips and tricks for a good positioning and implantation of the Mesh carotid stent: CGUARD™EPS
  • How to safely retrieve the embolic protection system: FilterWire EZ™?
  • What are adjunctive per procedural pharmacotherapies


Step-by-step procedure: Left internal carotid artery stenting

1) Access sites:

  • Femoral access: 8 French access using micro puncture system.
  • Heparin administration.

2) Left common carotid artery catheterization:

  • Continuous flushing of the guiding catheter while introducing guidewire, embolic protection device, balloons or stent.
  • Advance softly an 8 Fr Hockey Stick guiding catheter to the aortic arch over a 0.035’’ GUIDEWIRE
  • Gentle Catheterization of the ostium of the left common carotid artery.
  • Advance the 0.035” Guidewire towards the common carotid artery.
  • Advance the guiding catheter to the distal part of the common carotid artery with the tip oriented towards the internal carotid ostium.

3) Preparation and deployment of embolic protection system: FilterWire EZ™:

  • Preparation of the filter with a special attention to avoid air bubbles.
  • Preform the wire tip shape according to the lesion morphology.
  • Careful and gentle crossing of the lesion avoiding plaque destabilization.
  • Release the filter in a vertical segment of the internal carotid distally to the lesion: be sure to have enough space for stent distal landing zone.
  • Verify the good position and the opening of the filter under fluoroscopy.

4) Pre-dilatation

Atropine administration

  • Good balloon preparation: avoid air bubbles to avoid cerebral air embolism in case of balloon rupture.
  • Pre dilatation of the lesion using a 4*20mm Ultra-Soft™ balloon , inflated to 4 ATM
  • Checking pre dilatation result

5) Stenting

  • Select the precise spot of stent deployment
  • Deployment of the CGUARD™EPS 9x30 mm Stent

6) Post-dilatation

  • Post dilatation of the lesion using a 5,5 *20mm Ultra-Soft™ balloon. Inflated to 15 ATM
  • Checking post dilatation result

7) CT scan after procedure showed : Excellent deployment of the stent

  • Check the filter content and the quality of the flow.
  • Remove the filter.
  • Verify if there is any dissection or spasm.

8) Final angiographic control: Cervical and Intra-cranial ( 2 views frontal & lateral)

9) Vascular femoral closure with an 8 Fr Angio-Seal™

10) Medical adjunctive treatments

  • Pre-procedural: Heparin.
  • During procedure : Atropine and ephedrine
  • Post procedural : double therapy: Aspirin 75mg o.d. + Clopidogrel 75mg o.d for one month
  • After one month : Stop Clopidogrel and continue Aspirin 75mg



Shooting date : 2022-05-04
Last update : 2023-07-11
Max Amor
Essey-lès-Nancy, France
Julien Lemoine
Essey-Lès-Nancy, France

Our Cases of the Month

The case of the month is a new way for our users to watch, learn, and share with incathlab. They can watch a video that highlights an innovative case and uses excellent pedagogical techniques, lear...

1 comment
Join the Discussion
  • Mohamed amine R.

      Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
      Your browser doesn't have Flash, Silverlight or HTML5 support.


    Recanalization for limb salvage

    Three occlusions: femoral, popliteal and posterior tibial arteries - Case of the month: December 201...

    Scroll Up