Tips and techniques in carotid artery stenting

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Presentation transcript:

Tips and techniques in carotid artery stenting Rajesh K. Malik, MD, Ageliki Vouyouka, MD, Alexander Salloum, MD, Michael L. Marin, MD, Peter L. Faries, MD Journal of Vascular Surgery Volume 50, Issue 1, Pages 216-220 (July 2009) DOI: 10.1016/j.jvs.2009.01.040 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 Difficult left common carotid artery access, bovine arch configuration. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 Patient has a lesion in the common carotid artery and sheath access has been obtained by advancing over a 3-cm Amplatz wire and J tip. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 Sheath access obtained by advancing over a reverse curve catheter using a slip catheter technique. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 4 PercuSurge filter device served as a buddy wire (arrow) to straighten out the internal carotid artery. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 5 Left, A 62-year-old man with cervical irradiation and laryngectomy for laryngeal cancer was found to have high-grade internal carotid artery stenosis on duplex examination (543 cm/204 s). Right, Angiography shows the lesion. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 6 Patient required a buddy wire system to attempt to pass the PercuSurge filter device, but it was unable to be tracked over a BMW wire (Guidant Corp, Temecula, Calif). This was switched out for an Ironman wire (Guidant) and this wire would not track up. The BMW wire was reinserted, and an Ironman wire was passed. Subsequently the BMW wire was removed and the PercuSurge device was tracked over the Ironman wire. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 7 PercuSurge as a filter device. A, Flow is shown in the internal carotid artery with the balloon partially inflated and (B) then cessation of flow with the balloon completely inflated. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 8 Restenosis treated with a cutting balloon. A, Restenotic lesion; B, filter in place with cutting ballon (arrow); and (C) completion angiogram. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 9 A, PercuSurge filter device in place (white arrow) and (B) no flow with the balloon inflated (black arrow). C, After aspiration and filter removal, the completion angiogram is as shown. Journal of Vascular Surgery 2009 50, 216-220DOI: (10.1016/j.jvs.2009.01.040) Copyright © 2009 Society for Vascular Surgery Terms and Conditions