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

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

Case of the month: November 2017

This 18 minutes didactic recorded procedure concerns a 68 years old 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 now 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

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Acute Occlusions of Dual-Layer Carotid Stents After Endovascular Emergency Treatment of Tandem Lesions - Article
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Initial clinical experience with the micromesh Roadsaver carotid artery stent for the treatment of patients with symptomatic carotid artery disease - Article
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One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field - Article
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