Thrombus Aspiration and Sequential Stenting in Bilateral Carotid Arteries for a Patient with Takayasu Arteritis Tianjin First Center Hospital Lu Chengzhi.

Slides:



Advertisements
Similar presentations
Management of LCA-LM dissection.
Advertisements

Call for CASES Motaz AbuSamra Krzysztof Milewski CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland Head of Department:
Bifurcation LAD/D2 lesion. Provisional T stenting.
William Beaumont Hospital Royal Oak, Michigan
My unforgettable emergency case ---The emergency PCI strategy in the all three vascular obstruction case 宣武医院心脏科 许骥 郝恒剑.
Vertebral Artery Stenting VIST meeting 12 th October Dr Andrew Clifton Atkinson Morley Wing St George’s Hospital.
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.
Call for CASES One Stage Coronary And Peripheral Intervention (OCAPI) in a patient with accelerated diffuse atherosclerosis after chest irradiation. One.
Call for CASES Leszek D. Stachaczyk, MD Pawel Buszman, MD, FESC, FSCAI American Heart of Poland, Ustroñ, Poland & CCU, Upper-Silesian Center of Cardiology,
One stage coronary and peripheral intervention Pawel Buszman, MD, American Heart of Poland, Ustron Silesian Medical School, Katowice.
VIABAHN Endoprosthesis for Severe Femoropopliteal Lesions 舒 畅 Dept. of Vascular Surgery, The 2nd Xiang-Ya Hospital, Central-South University 中南大学湘雅二医院血管外科.
Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis Dr. Quan, Dr. Mirhashemi, Dr. Chiang N Engl J Med 2006; 355:
Stable Coronary Artery Disease. Case Presentations.
Unstable angina and arterial hypertension Leszek Kinasz, MD American Heart of Poland Ustron, Poland.
DR. ZAHOOR 1.  A 50 year old man presents to clinic with a complaint of central chest discomfort of 2 weeks’ duration, occurring after walking for more.
VULNERABLE PLAQUES: Pertinent doubts and solutions in interventional cardiology EuroPCR Paris, 16 May 2006.
Medical Grand Rounds Clinical Vignette October 15 th, 2008 Srikant Duggirala, M.D.
Server Stenosis of LCX Orifice and bad stenting final result : Short Period follow-up(6Ms) People’s Hospital of Zhengzhou Universty, PR China ( 河南省人民医院.
PCI in Left Main Coronary Bifurcation Disease -Step Mini Crush
After Deep-Seating… -Case Report- Zheng WU, MD Hongbing YAN, MD Beijing Anzhen Hospital Capital Medical University,Beijing,China.
IVUS evaluation TAP technology for unprotected left main bifurcation lesions interventional therapy Yong-Sheng Ke. MD Department of Cardiology, Yijishan.
Thrombocytopenia After PDA Occlusion 动脉导管未闭封堵术后血小板减少症 1 例 Xu Li (徐 立) Wang Lefeng (王乐丰) Heart Center, Beijing Chaoyang Hospital 北京朝阳医院 Beijing Chaoyang.
In-Stent Thrombosis or Acute Heart Failure ?. History Male, 64yrs Persistent chest pain 22hrs,admitted on 1st Mar. 2011,the symptom did not relieve at.
One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China.
Shujuan Cheng,MD; Hongbing Yan,MD Beijing Anzhen Hospital Capital Medical University, Beijing China Argatroban for Severe Thrombocytopnia after Primary.
Endovascular treatment on tandem lesions of cranial arteries Xiao-Long Zhang, MD, PhD Department of Radiology Huashan Hospital,Fudan University Shanghai.
A Case of LM , Bifurcation, CTO PCI and…Complications
Range & Specifications CASE #1: 80% stenosis of the left renal artery located at the ostium of the vessel. HELIOS 6x13.
2009 CIT CASE REVIEW Li Weijie Department of Cardiovascular Medicine, Xijing Hospital.
Nan Jia, Xiaobo Li, Bo Tao, Xiaofeng Tang Shaoli Chu, Pingjin Gao Department of Hypertension Ruijin Hospital Shanghai Jiao Tong University School of Medicine.
NYU Medical Grand Rounds Clinical Vignette Jeremy R. Beitler MD, PGY-2 December 16, 2009 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
One case of huge intracoronary thrombus in a patient of AMI Department of Cardiology,Shanghai Tenth People’s Hospital of Tongji University Li Weiming 李伟明.
Coronary Angiography, PCI & Cinemaps / Coronary Tree Diagrams Mike McAleer, Charge Nurse Manager CardioVascular Unit (CVU) July 2009.
KIDNEY & HYPERTENTION 1 Dr. Ruba Nashawati. Kidney Hypertension 2.
SCAI Fall Fellows Course 2012 Subclavian/Innominate Case Presentation Daniel J. McCormick DO, FACC, FSCAI Director, Cardiovascular Interventional Therapy.
Dr. Quan, Dr. Mirhashemi, Dr. Chiang
Ivo Petrov, L.Grozdinski, M.Pavlova
Open cervical approach for carotid artery stenting
Adel Gamal, MD and Mohamed Saber, Msc
Repair of a Thoracic Aorta Aneurysm
Successful transdradial removal of a dislodged coronary stent
Nightmares in the Cath Lab
Interesting Case Presentation
A strange post-CABG presentation
Guideliner related stent stripping
Clinical Presentation
Tubular LMS stenosis. LCx ostial stenosis
Tarek Abou Ghazala, MD, FACC, FSCAI
Zeeshan Khan, MD Second Year Cardiology Fellow
Meruzhan Saghatelyan, MD, Interventional cardiologist
A. Holden, A. Hill, M.R. Jaff, H. Pilmore  Kidney International 
History : Case March 26, year old male patient with complaints of left calf pain (Typical Claudication) at rest and on exertion (Fontaine II/B).
CASE HISTORY ISCHEMIC HEART DISEASE
Complex PCI to CTO lesion in RCA with nightmares complications
Crescendo angina in Distal Left Main CTO
Stenting of Single Remaining Pulmonary Artery
PCI in patients with cardiogenic shock associated with acute occlusion of the left main coronary artery.
Session Date: 28th Nov’14 Session Time: 14:30 – 16:00
Case presentantion 73-year old female
Giuseppe Lanzino, MD, Alejandro A. Rabinstein, MD, Robert D. Brown, MD 
Resistant Hypertension: Initial Combinations of Medications
Bailout emergency stenting of unprotected ostial left main coronary artery for acute catheter-induced occlusion during diagnostic coronary angiography 
A simple practical technique to protect the side branch during PCI for coronary bifurcation lesions: Side branch balloon submerged embedding technique 
Train-the-Trainer Cases
The giant cell arteritides: Diagnosis and the role of surgery
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.
Ruth L. Bush, MDa, Sasan Najibi, MDa, M. Julia MacDonald, RNa, Peter H
Presentation transcript:

Thrombus Aspiration and Sequential Stenting in Bilateral Carotid Arteries for a Patient with Takayasu Arteritis Tianjin First Center Hospital Lu Chengzhi Guo qianyu Chen xin 天津市第一中心医院心内科 卢成志 郭倩玉 陈欣

History Female , 36 years old Chief complaint: intermittent amaurosis for one month, arose from exertion, accompanied with tumbling Past history: Takayasu arteritis and pulmonary fibrosis for 3 years under oral prednisone management

Physical Examination RUE/LUE pulseless, LLE pressure 170/80 mmHg, RLE pressure 130/80 mmHg III/6 systolic murmurs in left carotid artery. Both lung clear. HR 72 bpm , regular rhythm, no murmurs.

Laboratory Investigations Blood Rt : Hb 110g/L WBC6.1X10 9/L Liver function and renal function: normal TC 6.31mmol/L TG 1.64mmol/L TC 6.31mmol/L TG 1.64mmol/L ESR : 18mm/h CRP : 0.76mg/dl Immune antibodies : SSB(+) SSB(+) SSA(+) SSA(+) ANA: 1 : 100 ANA: 1 : 100 others:(-) others:(-)

Auxiliary Examinations ECG : normal UCG: normal

Angiography Examination CAG : 40% stenosis in LM ostium LAD normal LAD normal LCX normal LCX normal RCA normal RCA normal Ceberal angiography: : Brachiocephalic trunk occlusive. Brachiocephalic trunk occlusive. Left carotid artery subtotal occlusive. Left carotid artery subtotal occlusive. Left subclavian artery: 90% stenosis Left subclavian artery: 90% stenosis left vertebral artery: 95% stenosis in ostium left vertebral artery: 95% stenosis in ostium

Brachiocephalic trunk occlusive Left carotid artery subtotal occlusive Left subclavian artery: 90% stenosis left vertebral artery: 95% stenosis in ostium

Treatment strategy Conservative therapy? Interventional therapy? Carotidendarterectomy?

Treatment strategy Medication : prednisone cyclophophamide cyclophophamide Interventional therapy : first step: stent in right carotid artery first step: stent in right carotid artery second step: stent in left carotid artery second step: stent in left carotid artery

Stenting in right carotid artery ( ) Approach : right femoral artery Equipment : 8F MPA1 Guiding catheter 8F MPA1 Guiding catheter guide wire guide wire distal end protective umbrella distal end protective umbrella 2.0×20mm×mm Avion balloon 2.0×20mm×mm Avion balloon thrombus aspiration catheter thrombus aspiration catheter 5.0×40mm Submarine balloon 5.0×40mm Submarine balloon 7.0×40mm Precise stent 7.0×40mm Precise stent

2.0×20 balloon dilation 2.0×20 balloon dilation After dilation

Distal end potective unmbrella 5.0×40mm balloon

After thrombus aspiration Thrombus before aspiration

7.0×40 Precise stent Post dilation

Final result

Postoperative treatment Aspirin 300 mg and clopidogrel 75 mg Nifedipine to control BP Prednisone The patient’s ESR rose transiently and then fell normal, she didn’t feel dizziness or amaurosis any more.

Stenting in left carotid artery ( ) Approach : right femoral artery Equipment : 8F MPA1 Guiding catheter 8F MPA1 Guiding catheter 2 guide wire 2 guide wire 2.0×20mm×mm Invatec balloon 2.0×20mm×mm Invatec balloon distal end protective umbrella distal end protective umbrella 5.0×30mm Invatec balloon 5.0×30mm Invatec balloon 7.0×40mm Cordis stent 7.0×40mm Cordis stent

2.0×20mm×mm Invatec balloon Before operation right carotid artery

5.0×30mm Invatec balloon 7.0×40mm Cordis stent Final result

Discussion Endovascular interventional therapy: an approach to occlusive lesion of arteritis: Is it a suitable option? Thrombus aspiration: the first attempt dealing with thrombotic complications of stenting in carotid: Is it a lucky hit or a mandatory practice? medication or stenting in subclavian artery: Is it done or overdone? Antiplatlete therapy: duration and dosage.

Follow up No dizzness or amaurosis until now ESR mm Medication: prednisone 5 mg QD prednisone 5 mg QD Aspirin 100 mg Aspirin 100 mg clopidogrel 75 mg QD for 6 Months clopidogrel 75 mg QD for 6 Months 8 month later CTA examination

8 months later CTA show restenosis Stent in right carotid artery

Stent in left carotid artery

Discussion What to do with restenosis now: Intervention: bilateral balloon dilation? Intervention: bilateral balloon dilation? Conservative treatment? Conservative treatment? Carotidendarterectomy? Carotidendarterectomy?