Slow-Flow During Carotid Intervention

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Presentation transcript:

Slow-Flow During Carotid Intervention Ochsner Clinic Foundation New Orleans

History 62 year old attorney with asymptomatic bruit. Critical stenosis by CFD. High bifurcation. Offered surgery, refused. Referred for Carotid Stent. Obtained coverage from his insurance company.

Baseline angiogram

Baseline angiogram

Baseline angiogram

Baseline angiogram

Baseline Angiogram

Sheath in place RCCA

Lesion crossed with buddy wire

Filter deployed distal ICA

Slow flow post stenting

Normal Flow after aspiration and filter removal

Before and After Stenting

Post intervention

Post intervention

4 hours after procedure Nurse notifies staff MD Complications/Patient complains of Decreased visual acuity Right sided headache What happened? What should we do?

Emboli to Retinal Artery Baseline 18 Seconds 70 Seconds

Fluoroscine Angiogram of the Retina

Follow up With ophthalmologist, neurologist and Interventional cardiologist at 1 month Ophthalmology note Vision improving Multiple bright emboli but less than initially Continue on Aspirin and plavix

Conclusion Atheroemboli occur in virtually all interventions. They are a marker for adverse outcomes with angioplasty in all vascular beds. Emboli in the coronary and carotid beds are especially important clinically. We have proven that embolic protection makes percutaneous intervention safer than intervention without protection (SAFER) in SVG’s. To assume that embolic protection will prevent all emboli is naive. When slow flow occurs, immediate and vigorous aspiration is required to remove the debris that is in solution in the stagnant column.!