1. John Ochsner Heart and Vascular Institute
Carotid Cases
J.P. Reilly, MD, FSCAI
John Ochsner Heart and Vascular Institute
New Orleans, LA

9. Case 74 year old woman with CAD CCS Class I No neurologic symptoms
Carotid Duplex reveals severe RICA

18. Summary Be wary of vessel tortuosity
Vessel may shift when inserting guide, wire or stent

19. 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.

20. Baseline angiogram

21. Baseline angiogram

22. Baseline angiogram

24. Baseline angiogram

25. Baseline Angiogram

26. Sheath in place RCCA

27. Lesion crossed with buddy wire

28. Filter deployed distal ICA

29. Slow flow post stenting

30. Normal Flow after aspiration and filter removal

31. Before and After Stenting

32. Post intervention

33. Post intervention

34. 4 hours after procedure Nurse notifies staff MD
Complications/Patient complains of
Decreased visual acuity
Right sided headache
What happened?
What should we do?

35. Emboli to Retinal Artery
Baseline
18 Seconds
70 Seconds

36. Fluoroscine Angiogram of the Retina

37. 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

38. 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.!

39. Case 77 year old man history of CHF and AF
On anticoagulation, but has trouble resisting vegetables
Presented with stuttering TIA symptoms