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CASE20191101_008
| ENDOVASCULAR - Carotid & Neurovascular Intervention | |
| Percutaneous Transluminal Angioplasty of the Left Common and Internal Carotid Artery Through the Aorta | |
| Alexey Biryukov1, Aleksey Bazunov1 | |
| Pavlov First Saint Petersburg State Medical University, Russian Federation1, | |
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[Clinical Information]
- Patient initials or identifier number:
B
-Relevant clinical history and physical exam:
The patient, 56 years old, admitted to the clinic with complaints of dizziness and frequent headaches, nausea, pain in the lower extremities of the type of intermittent, numbness of the lower extremities of fingers, no ripple on the femoral arteries and the arteries of the lower leg. Underwent duplex ultrasound of the brachiocephalic artery: Right - internal and external carotid stenosis with 50%, VPS 50-90 cm/sec. LEFT - internal and external carotid stenosis with 50%, VPS 50-90 cm/sec.
-Relevant test results prior to catheterization:
Angiography results: Occlusion of the aorta below the artery mesenteric inferior, iliac arteries on both sides. ¬³erebral angiography: pronounced calcification, occlusion of the right C4, stenosis of the common carotid artery to the left 80%, stenosis of the left internal carotid artery 75%, stenosis of the right vertebral artery 75%, stenosis of the left vertebral artery 75% stenosis of the artery basilaris.
 se022.mpg- Relevant catheterization findings:
Catheterization of the left brachial artery was performed, the sheath 6Fr (Terumo) was installed. Through aortic puncture was performed with Destination 6F (Terumo) in the left common carotid artery. A stent ¡°Protege RX¡± 8-6 x 30 mm (Medtronic) was implanted in the left internal carotid artery. Post-dilatation with a 5 x 20 mm balloon catheter. Then, a Carotid WALLSTENT 7-50 mm (Boston Scientific) stent was implanted into the left common carotid artery.
se032.mpg se037.mpg |
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[Interventional Management]
- Procedural step:
A decision on the performance of PTA ¬ãommon and internal carotid arteries. Catheterization of the left brachial artery was performed, the sheath 6Fr (Terumo) was installed. Through aortic puncture was performed with Destination 6F (Terumo)in the left common carotid artery. A stent ¡°Protege RX¡± 8-6 x 30 mm (Medtronic) was implanted in the left internal carotid artery. Post-dilatation with a 5 x 20 mm balloon catheter. Then, a Carotid WALLSTENT 7-50 mm (Boston Scientific) stent was implanted into the left common carotid artery. After 6 hours, Destination (Terumo) under the cover of a hydraulic ¡°pillow¡± 150 ml of 0.25% novocaine removed. After the remova lof Destination (Terumo), the patient was transferred to the ward, after 2 days he was discharged with no complaints and positive neurological dynamics for outpatient treatment.
se023.mpg se031.mpg se035.mpg- Case Summary:
In patients of type 3 and Lerish¡¯s syndrome, surgery through radial and femoral access is not possible. Decision-making on conducting transluminal access to angioplastics with a common and internal artery.
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