1. 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

2. Preoperative scanning

3. Carotid Triplex high grade stenosis of internal carotid artery

4. MRA (magnetic res angiography)

5. Digital subtraction angiography (DSA)

6. CT csan Μικροέμφρακτα βασικών γαγγλίων άμφω

7. MRI (magnetic res. imaging) Huge right hemispheric infarct

8. Carotid stenting procedure

9. 1 st case

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

11. Initially Cerebral protection device is deployed

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

13. Stent deployment

14. Post deployment we dilate the stent with a balloon

15. The stent is fully deployed

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

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

18. 2 nd case

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

20. Difficulty to pass the stent from the stenosis

21. Pre dilation with coronary balloon 3 χ 12 mm

22. Stent deployment (SE 6-8 x 40 mm)

23. Post deployment dilation with 5 Χ 30 mm balloon

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

25. 2 nd post dilation

26. Final angiography

27. CASE 3 Post stenting Prior to stenting

28. CASE 4 Prior to stenting

29. CASE 5 Post stenting Prior to stenting

30. CASE 6 Prior to stenting

31. CASE 7 Post stenting Prior to stenting

32. CASE 8 Prior to stenting Post stenting

33. CASE 9 Prior to stenting Post stenting

34. CASE 10 Prior to stenting Post stenting

35. CASE 11 Post stenting Prior to stenting

36. CASE 12 Post stenting Prior to stenting

37. CASE 13 Post stenting Prior to stenting

38. CASE 14 Post stenting Prior to stenting

39. CASE 15 Post stenting Prior to stenting

40. CASE 16 Post stenting Prior to stenting