Any help is appreciated!
CO-SURGEON:
Dr. D, MD
PROCEDURE PERFORMED:
Intracerebral angiogram, left carotid angiogram, stenting of the left
internal carotid artery with proximal protection using a Moma device.
COMPLICATIONS:
None.
ESTIMATED BLOOD LOSS:
30 mL including the waste of the Moma. Closure Angio-Seal.
INDICATION FOR PROCEDURE:
TIA/stroke with significant left internal carotid artery stenosis of
85% based on NASCET criteria. High risk for surgery given inaccessible
surgical location of the lesion in the cervical portion of the carotid.
DESCRIPTION OF PROCEDURE:
After informed consent discussion of risks and benefits, a 9-French sheath
was placed in the right common femoral artery under ultrasound guidance.
A 3DRC catheter was used to cannulate the carotid selectively angiography
was performed, which confirmed 85% stenosis and the intracranial circulation
was studied. Following that, we cannulated the external carotid artery.
The Moma device was advanced into the external carotid artery with the
distal balloon being in the external and the proximal and common. The
balloons were inflated with occlusion of flow. The patient tolerated
it well. We got across with a BMW wire, following which balloon. The
patient was anticoagulated throughout with a therapeutic ACT. Balloon
angioplasty was done with a 4.0 x 40 balloon, following which a 7 distal
x 10 proximal tapered stent was deployed. The stent was postdilated
with a 5.0 balloon. The patient did have bradycardia, which responded
to 0.5 mg of atropine and fluids. There were no complications. Final
angiography showed excellent flow. Intracranial angiography showed it
to be unchanged. The patient was
asymptomatic at the end of the procedure. The sheath was removed and
Angio-Seal closure device with good hemostasis.