Zeeshan Khan, MD Second Year Cardiology Fellow

Slides:



Advertisements
Similar presentations
William Beaumont Hospital Royal Oak, Michigan
Advertisements

Menaka Nadar, MD University of Virginia. CC: Acute onset abdominal pain HPI: 43 year old male with a history of Marfan’s syndrome presented to outside.
Vertebral Artery Stenting VIST meeting 12 th October Dr Andrew Clifton Atkinson Morley Wing St George’s Hospital.
Viabahn Covered Stents for Cephalic Arch Stenosis Can Improve Patency and Longevity of Upper Arm AV Fistulas Toufic Safa, MD, FACS Vascular & Endovascular.
HEAPHY 1 & 2 CASE RACE 1 – DIAG Rowena OLIVER Sat 31 st Aug 2013 Session 3 / CR1-6 13:26 – 13:30 OTAGO / SOUTHLAND ABSTRACT A case of a 81 year old female.
Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Over 400 Screening for Coronary Artery.
NYU Medical Grand Rounds Clinical Vignette Jacqueline Lonier, PGY2 November 3rd, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Call for CASES Leszek D. Stachaczyk, MD Pawel Buszman, MD, FESC, FSCAI American Heart of Poland, Ustroñ, Poland & CCU, Upper-Silesian Center of Cardiology,
‘Taxi Driver in Pain’ Tiara Gill Carrie Ross Mark Hambly.
Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.
Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis Dr. Quan, Dr. Mirhashemi, Dr. Chiang N Engl J Med 2006; 355:
Endovascular treatment on tandem lesions of cranial arteries Xiao-Long Zhang, MD, PhD Department of Radiology Huashan Hospital,Fudan University Shanghai.
ADMIRALADMIRAL Abciximab before Direct Angioplasty and Stenting in Myocardial Infarction Regarding Acute and Long term follow-up ADMIRAL Study ADMIRAL.
New embolic cerebral lesions detected with diffusion-weighted imaging after carotid artery and intracranial stent placement YH Chen, CJ Chen, DC Chen,
New strategies and perfusion/aspiration devices for primary PCI Sandra Garcia Cruset, PhD. Cordynamic B.U. Marketing Manager.
Vertebral PTA: Indications and Technique Patrick L. Whitlow, MD Director, Interventional Cardiology The Cleveland Clinic Foundation Patrick L. Whitlow,
Issued in 2014 – SCAAR. SCAAR Annual report 2013.
End points in PTCA trials. A successful angioplasty is defined as the reduction of a minimum stenosis diameter to
Date of download: 9/18/2016 Copyright © The American College of Cardiology. All rights reserved. From: Percutaneous Treatment of Protected and Unprotected.
From: Bivalirudin Versus Heparin With or Without Glycoprotein IIb/IIIa Inhibitors in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention:
Dr. Quan, Dr. Mirhashemi, Dr. Chiang
Mesenteric Ischemia: A Minimally Invasive Approach
M-Guard stent in STEMI patients with high thrombus burden lesions Mahmoud Shabestari Baktash Bayani Ali Eshraghi Bahram Shahri Mashhad University.
Amro Elnagar.MD Lecturer of cardiology Banha University Hospital
Open cervical approach for carotid artery stenting
Ultra-Low Contrast Volumes Reduces Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease Undergoing Neurointerventional Procedures eP-150.
Table 1: Table 2: Non Therapeutic Angiograms in Acute Ischemic Stroke Patients Being Considered for Endovascular Treatment Does not Adversely Affect Patient.
Radial Approach for CAS – tips for the novice Dr Georgi Goranov
The American College of Cardiology Presented by Dr. Adnan Kastrati
Guidelines for the Management of Patients With ST- Elevation Myocardial Infarction Adapted from Focused Updates: ACC/AHA 2009.
Guideliner related stent stripping
Clinical Presentation
Carotid Artery Stenting Predictors of procedural and clinical success
CRT 2017 Interventional Challenging Case Anterior ST- Elevation Myocardial Infarction Resulting From Acute Occlusion of Left Internal Mammary Artery Graft.
Management of ST-Elevation Myocardial Infarction
CASE REPORT BY DR FAWZY MEGAHED.
How to do endovascular mechanical thrombaspiration
Initial pharmacotherapy for ST-segment elevation myocardial infarction
Initial pharmacotherapy for ST-segment elevation myocardial infarction
Slow-Flow During Carotid Intervention
Complex PCI to CTO lesion in RCA with nightmares complications
Stent Thrombosis Rates in Contemporary Clinical Practice: Insight from a Large Australian Multi-centre Registry BP Yan*, TJ Kiernan, SJ Duffy, DJ Clark,
Ischaemic Heart Disease Acute Coronary Syndrome
Percutaneous Reconstruction of the Aortoiliac Bifurcation
On behalf of J. Belardi, M. Leon, L. Mauri,
A 68-year-old man with history of hypertension and coronary artery disease (coronary artery bypass graft surgery in the past) with no follow-up in the.
Case presentantion 73-year old female
Presented by Dr. Leif Thuesen
Glenn N. Levine et al. JACC 2016;68:
Tips and techniques in carotid artery stenting
Late Breaking Clinical Trials
Section F: Clinical guidelines
Figure 2 Ischaemic and bleeding outcomes in the major clinical trials
Giuseppe Biondi Zoccai, MD
Catheter-based neurosalvage for acute embolic complication during carotid intervention  Mao-Shin Lin, MD, Ying-Hsien Chen, MD, Chi-Chao Chao, MD, Cheng-Hsin.
A 66-year-old male patient with symptomatic left intracranial carotid artery stenosis treated with balloon-mounted stenting. A 66-year-old male patient.
American Heart Association Presented by Dr. Julinda Mehilli
Impact of Platelet Reactivity Following Clopidogrel Administration
Plain CT scan of head (a) and prethrombectomy (b, c), during thrombectomy (d, e, f) and post-thrombectomy (g, h) digital subtraction angiogram images in.
John Ochsner Heart and Vascular Institute
Train-the-Trainer Cases
A 66-year-old man with a calcified cerebral embolus to the left middle cerebral artery.A, Axial 2.5-mm image from a noncontrast brain CT scan shows a calcified.
Carotid endarterectomy and intracranial thrombolysis: Simultaneous and staged procedures in ischemic stroke  Hans-Henning Eckstein, MD, Hardy Schumacher,
Train-the-Trainer Cases
Train-the-Trainer Cases
A new approach to carotid angioplasty and stenting with transcervical occlusion and protective shunting: why it may be a better carotid artery intervention 
Concomitant asymptomatic internal carotid artery and persistent primitive hypoglossal artery stenosis treated by endovascular stenting with proximal embolic.
Major bleeding with bivalirudin versus unfractionated heparin (UFH) in predominantly non-ST segment elevation acute coronary syndrome (NSTE-ACS) studies;
A 44-year-old male patient with symptomatic left intracranial vertebral artery stenosis treated with balloon predilation plus self-expanding stenting.
Transcarotid Artery Revascularization versus Transfemoral Carotid Artery Stenting for Treatment of Carotid Artery Stenosis Patric Liang, MD; Marc L.
Presentation transcript:

Use of Intracarotid Abciximab to treat Embolism after Carotid Artery Stenting Zeeshan Khan, MD Second Year Cardiology Fellow University of Oklahoma Health Science Center.

HISTORY & PHYSICAL EXAM: 67 year old man with history of diabetes mellitus II, hypertension and pulmonary fibrosis admitted to hospital with cellulitis. Hospital course was complicated by Non ST elevation mycoardial infarction requiring left main stenting as he was not a good candidate for coronary artery bypass grafting. Ten days after the procedure he developed left sided weakness. Examination revealed decreased strength on left side with decreased sensation.He had complete resolution of symptoms over next thirty minutes.

Relevant Test Prior to Angiography: CT scan of Brain: No signs of acute intracranial process. Carotid Duplex: -70-79 % stenosis involving the right internal carotid artery. -50-69 % stenosis involving the left internal carotid artery.

Angiography: Type I carotid arch with bovine origin of left carotid artery. Right internal carotid artery has 80% stenosis and provides right and left communicating arteries and right middle cerebral artery. Left internal carotid artery has 50 % stenosis supplying only left middle cerebral artery

Interventional Management: 6 French Destination sheath was advanced into the right common carotid artery over a Rosen wire. Bivalirudin was started for anticoagulation. Emboshield embolic protection system was deployed in the prepetrous segment of carotid. Lesion was predilated with 3 x 30 balloon and 7 x 10 mm stent was deployed. This was post dilated and filter was withdrawn.

Interventional Management: At this point patient reported weakness in left arm and leg. Another angiogram was obtained with concerns for embolisation in M3 segment. Loading dose of intracarotid Abciximab was given promptly with resolution of symptoms with in 15 minutes. He was reloaded with clopidogrel. After carotid intervention another CT scan was obtained which was unchanged.

Conclusion: Embolization is a major risk in carotid artery stenting. Prior to the use of Embolic protection devices glycoprotein IIb/IIIa inhibitors were used to prevent this but there use declined mainly due to increased risk of bleeding. Though rare, even with the use of these devices, intraprocedural thromboembolic events occur and require prompt identification and treatment with intracarotid abciximab.