×
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
Video credit – Christian Vuolo – Synaps

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


86829 views

 

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

Multivascular patients management

Objectifs du cours Les patients Multivasculaires (plusieurs sites athéromateux), encore appelés polyvasculaires, représente 15% des patients explorés et prése...

Share

Suggestions

Scroll Up