Carotid Artery Stent Placement with Distal Balloon Protection: Technical Considerations
Jiri J. Viteka,
Nadim Al-Mubarakb,
Sriram S. Iyera and
Gary S. Roubina
a Lenox Hill Heart and Vascular Institute of New York, NY
b Fairview Hospital, Cleveland Clinic Health System, OH
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FIG 2. Application of the GuardWire protection system in a 62-year-old man with recent multiple transient ischemic attacks.
A, Right carotid angiogram shows significant stenosis in the ICA.
B, Angiogram shows that the balloon on the temporary occlusion catheter is inflated in the distal cervical segment of the ICA (stent is deployed and postdilated).
C, Carotid angiogram obtained after stent placement.
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FIG 3. A and B, Illustration of the buddy wire technique in an 82-year-old woman.
A, Left, Left carotid angiogram shows near occlusion of the ICA and significant tortuosity of the distal ICA. Initial attempt to pass the temporary occlusion catheter of the GuardWire protection system through the stenosis was unsuccessful due to the severity of the stenosis. Middle, Angiogram shows a buddy wire positioned through the stenosis and the distal tortuous segment of the ICA. Blood flow through the subocclusive stenosis is hindered by the guidewire with the predilation balloon. Right, Angiogram shows the stenosis predilated with a 3 x 20-mm coronary balloon.
B, Left, Angiogram shows the inflated balloon of the temporary occlusion catheter positioned distal to the stenosis along the buddy wire. Middle, Angiogram shows the postdilated stent. The buddy wire was removed before deployment of the 10 x 24-mm Wallstent. Right, Angiogram obtained after carotid artery stent placement.
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FIG 4. A and B, Illustration of the buddy catheter technique in a 70-year-old man.
A, Left, Left carotid angiogram shows near occlusion of the ICA. The 90° takeoff angulation made advancement of the GuardWire temporary occlusion catheter into the stenotic ICA impossible. Right, Angiogram shows the buddy catheter (5F, 125-cm JR4, arrow) positioned through a 6F guiding sheath, with its tip pointing into the angulated ICA lesion. The temporary occlusion catheter is advanced through the stenosis into the distal segment of the ICA.
B, Left, Angiogram shows that the inflated balloon of the temporary occlusion catheter is occluding the ICA. Right, Angiogram obtained after carotid artery stent placement. Two 10 x 30-mm Smart stents were deployed.
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FIG 5. Dissection caused by occlusion balloon in a 79-year-old man.
A, Right carotid angiogram shows near occlusion of the ICA.
B, Angiogram shows that the temporary occlusion balloon is inflated. Predilation was performed with a 4 x 40-mm balloon.
C, Follow-up angiogram obtained after carotid artery stent placement shows significant dissection at the level of the previously placed occlusion balloon. Satisfactory result of carotid artery stent placement with a 9 x 30-mm stent (Medtronic AVE).
D, Follow-up angiogram after placement of a 4 x 23-mm coronary stent in the dissected segment of the ICA.
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AJNR - American Journal of Neuroradiology