Carotid Artery Stenting throught Sheathless Femoral Approach

This case shows treatment of radiation-induced right internal carotid artery stenosis in patient with history of left carotid artery bypass.

Learning Points

• How to approch a high carotid artery stenosis.
• How to use sheathless system  to treat carotid lesions by femoral access.
• Minimizing femoral access related complications by using sheathless system.

Procedure description

• Right femoral artery puncture.
• Multi Purpose (MP) 7F guiding catheter introduction through Cordis Sheathless system and  Adventage 0.035 guidewire support.
• Deployment of the distal cerebral  protection device.
• Predilatation with 4.0x20mm balloon.
• Deployment of the Roadsaver stent.
• Optimizing stent apposition with a 6.0 mm balloon.
• Retrieving the distal protection device.
• Checking the cerebral circulation.
• Access point hemostasis with Femoseal 6F closure device.

Protocol

• Time of procedure: 55 min.
• Exposure time: 8:57 min.
• Raiation dose: 147 mGy.
• Contrast volume: 150 ml (Iomeron).