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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
