Case Presentation: Carotid With Proximal Protection

Complex Carotid artery
Stenting
Issam D. Moussa, MD, FSCAI
Professor of Medicine
Chair, Division of Cardiovascular Diseases
Mayo Clinic
Jacksonville, Florida
Disclosure Statement of Financial Interest
• Grant/Research Support
• Consulting Fees/Honoraria
• Major Stock
•
•
•
•
Shareholder/Equity
Royalty Income
Ownership/Founder
Intellectual Property Rights
Other Financial Benefit
• Medtronic, Baxter, Gilead
Case History
• 82 year old female admitted with NSTEMI and rightsided weakness
• Brain MRI / MRA showed left parietal stroke and severe
left ICA stenosis
• Neurological deficit improved over 1 week
• Patient transferred to us for further management
• PMH
– Hypertension
– Hyperlipidemia
– CAD
– Moderate COPD
– Arthritis
• Medications
– Lisinopril
– Lipitor
– Aspirin
– Albuterol inhaler
Physical Examination
• Temperature: 36.5o C HR: 63 bpm, BP 145/88 mmHg Sat:
95% RA
• General: Alert, in no apparent distress.
• Neck: left carotid bruits, no JVD
• Heart: RRR. NL S1, S2, no mumurs, no LE edema
• Lungs: Clear to auscultation.
• Abdomen: Soft, nontender, no bruits
• NeurologicalExam: Left arm/leg weakness (3/5)
Coronary Angiography
Aortic Arch Angiography
Selective LICA Angiography
A challenging CCA Access
Simmons 2 catheter
0.038” glide wire with
Simmons 2 catheter
Simmons 2 catheter exchanged for
0.035” Quick Cross catheter
Tad wire inserted through the
Quick Cross catheter
A 6.5 Fr. JB1 catheter advanced
over the Tad Wire
The Tad wire Was exchanged
for the SupraCore wire
The MoMa device advanced
over the SupraCore wire
Carotid Stent Deployment and Post Dilatation
CP1167825-76