Carotid artery stenting for carotid artery stenosis Dr

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

MRI (magnetic res. imaging) Huge right hemispheric infarct

Carotid stenting procedure

st 1 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

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

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

nd 2 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

Prior to stenting CASE 3 Post stenting

Prior to stenting CASE 4

Prior to stenting CASE 5 Post stenting

Prior to stenting CASE 6

Prior to stenting Post stenting CASE 7

CASE 8 Prior to stenting Post stenting

CASE 9 Prior to stenting Post stenting

CASE 10 Prior to stenting Post stenting

CASE 11 Prior to stenting Post stenting

CASE 12 Prior to stenting Post stenting

CASE 13 Prior to stenting Post stenting

CASE 14 Prior to stenting Post stenting

Prior to stenting CASE 15 Post stenting

CASE 16 Prior to stenting Post stenting