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This didactic procedure concerns a 72 years old women with a history of hypertension and Diabetes, she presented weight loss of 10 kilograms, distaste of meal and post prandial with pain one month before investigation.
CT scan showed: Complete occlusion of calcified celiac trunk with Severely calcified stenosed mesenteric artery. A collateral Riolan arc is present from inferior mesenteric artery to superior mesenteric artery. See CT figures

Educational objectives

  • Plan a step-by-step procedure.
  • How to select and brachial access.
  • Use of IVL before stenting
  • How to proceed to a safe and successful positioning of the endoprosthesis?
  • Materials choice.
  • Tips and tricks for vessel preparation a good endoprosthesis positioning
  • Endoprosthesis deployment.


Step-by-step procedure:

1) Vascular imaging: CT/angiographic imaging

  • Identifying the localization and the extent of the lesion
  • Identifying the adjacent vessels that could interfere with the stent
  • Identifying access challenges: vessel stenosis, tortuosity, anatomy

2) Vascular access

  • 1st access: right brachial access: Gentle navigation through the brachial artery and advance a 90cm 6 Fr braided sheath introducer
  • Crossing of mesenteric stenosis with JR4 5F 125cm and a 300 cm 0.014” Guidewire
  • Dilatation with IVL catheter

3) Mesenteric artery stenting

  • Identifying the proximal and distal landing zone
  • Crossing of mesenteric stenosis with JR4 5F 125cm and a 300 cm 0.014” Guidewire
  • Wiring lesion with a 0.014 ” Spartacore
  • Dilatation with IVL catheter
  • Advancement of the balloon Athletis 5 x 4 x 135 cm with active control with gentle navigation
  • Predilatation with 12 ATM
  • Angiographic control after predilatation
  • After predilatation : Positioning of the endoprosthesis.
  • Important remarks to take into consideration while positioning the endoprosthesis:
  • Angiographic control of the position of the endoprosthesis

4) Deployment of the endoprosthesis

  • Opening of the endoprosthesis
  • Angiographic control of the deployment and the position of the first struts
  • Adjust the endoprosthesis position up/downstream for an optimal positioning
  • Complete opening of the endoprosthesis from distal to proximal
  • Complete deployment after release the angulation control
  • Angiographic control of the final endoprosthesis position

5) Vascular closure with manual compression

6) Clinical observation and Follow-up in CCU for 24h.

7) CT scan after procedure showed : Excellent deployment of the stent . Minimal residual stenosis







Shooting date : 2022-09-01
Last update : 2023-07-11
Max Amor
Essey-lès-Nancy, France
Julien Lemoine
Essey-Lès-Nancy, France

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