Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.

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Presentation transcript:

Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department of Surgery, Aristotle University of Thessaloniki, Greece Associate in Interbalcan Medical Center

Preoperative scanning

Carotid Triplex high grade stenosis of internal carotid artery

MRA (magnetic res angiography)

Digital subtraction angiography (DSA)

CT csan Μικροέμφρακτα βασικών γαγγλίων άμφω

MRI (magnetic res. imaging) Huge right hemispheric infarct

Carotid stenting procedure

1 st case

Initial angiography severe internal carotid kinking (red arrow) High grade ostial stenosis in internal carotid artery (κίτρινο βέλος)

Initially Cerebral protection device is deployed

Pre stenting angiography the yellow arrow shows the stenosis to be dilated

Stent deployment

Post deployment we dilate the stent with a balloon

The stent is fully deployed

The carotid artery is now patent without residual stenosis. The kinking has not changed. Initial angiography Operative time 10 min Final angiography

Crossing the lesionCerebral protection filter Stent deployment and balloon dilatation Filter removal Basic steps in carotid stenting

2 nd case

Initial angiography severe internal carotid kinking (red arrow) High grade, long in length stenosis in internal carotid artery (κίτρινο βέλος)

Difficulty to pass the stent from the stenosis

Pre dilation with coronary balloon 3 χ 12 mm

Stent deployment (SE 6-8 x 40 mm)

Post deployment dilation with 5 Χ 30 mm balloon

Angiography after first post dilation there is still a residual stenosis (red arrow)

2 nd post dilation

Final angiography

CASE 3 Post stenting Prior to stenting

CASE 4 Prior to stenting

CASE 5 Post stenting Prior to stenting

CASE 6 Prior to stenting

CASE 7 Post stenting Prior to stenting

CASE 8 Prior to stenting Post stenting

CASE 9 Prior to stenting Post stenting

CASE 10 Prior to stenting Post stenting

CASE 11 Post stenting Prior to stenting

CASE 12 Post stenting Prior to stenting

CASE 13 Post stenting Prior to stenting

CASE 14 Post stenting Prior to stenting

CASE 15 Post stenting Prior to stenting

CASE 16 Post stenting Prior to stenting