OCT for Symptomatic Right internal Carotid Artery stenting .Right Radial Access

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:

• Pullback with an Imaging catheter, C7 DragonFly, St. Jude Medical advanced upon the guidewire of the Emboshield system 

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