COMPLEX POST RADIOTHERAPY RIGHT INTERNAL CAROTID ARTERY STENOSIS

Case presentation

Clinical Data

• Man, 82 years,
• HTN, past smoking
• Cancer of the tongue treated with radiotherapy
• Occlusion of the Left internal carotid artery
• Severe stenosis of the right internal carotid artery
• Unsuccessfull surgical attempt to revascularize the right internal carotid artery

Previous Imaging

Angio:

• Severe, long, irregular and sinuous stenosis of the right internal carotid artery, 1,5 cm above the bifurcation
• Occlusion of the Left Internal Carotid artery
• Poor suppleance from the right carotid to the left territories which depends almost exclusively on left vertebral vascularization 

Steps of the procedure:

1. access: 

• Right femoral access, 8F, 23 cm BRITE TIP ® sheath, Cordis
• Selective Catheterism  of the Right Common Carotid Artery with a H-Stick 8F, 100 cm Guiding Catheter (Cordis),

2. Distal embolic protection device placement

• Deploiement of an Emboshield Pro Filter Carotid Protection ( Abbott Vascular)

3. Predilation, stenting and postdilation:

• Predilation with a 4 x 30 mm TREK Coronary Balloon, Abbott
• Deploiement of a 7-9 x 60 mm X-ACT Closed Cells Stent ( Abbott Vascular)
• Postdilation with a 6 x 20 mm  balloon

4. Retrieval af the filter