Carotid artery stenting for carotid artery stenosis

Dr. Nikolaos Melas, PhDVascular and Endovascular Surgeon

 Military Doctor

Associate in 1st 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)

CT csan

Μικροέμφρακτα βασικών γαγγλίων άμφω

MRI (magnetic res. imaging)

Huge right hemispheric infarct

Carotid stenting procedure

1st case

Initial angiographysevere internal carotid kinking (red arrow)

High grade ostial stenosis in internal carotid artery (κίτρινο βέλος)

Initially Cerebral protection device is deployed

Pre stenting angiographythe yellow arrow shows the stenosis to be dilated

Stent deployment

Post deployment we dilate the stent with a balloon

The stent is fully deployed

The carotid artery is now patent without residual stenosis. The kinking has not changed.

Initial angiography

Operative time 10 min

Final angiography

Crossing the lesion Cerebral protection filter

Stent deployment and balloon dilatation

Filter removal

Basic steps in carotid stenting

2nd case

Initial angiographysevere 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 dilationthere is still a residual stenosis (red arrow)

2nd post dilation

Final angiography

CASE 3

Post stenting

Prior to stenting

CASE 4

Prior to stenting

CASE 5Post stenting

Prior to stenting

CASE 6

Prior to stenting

CASE 7

Post stentingPrior to stenting

CASE 8Prior to stenting Post stenting

CASE 9

Prior to stenting Post stenting

CASE 10Prior to stenting Post stenting

CASE 11

Post stentingPrior to stenting

CASE 12

Post stentingPrior to stenting

CASE 13Post stentingPrior to stenting

CASE 14

Post stenting

Prior to stenting

CASE 15

Post stentingPrior to stenting

CASE 16

Post stentingPrior to stenting