Author + information
- Wei Da Lu1
Patient initials or identifier number
Relevant clinical history and physical exam
A 57-year-old man who has the history of right internal carotid artery total occlusion s/p stent*2, right middle cerebral artery infarct s/p tissue plasminogen activator on 2015/10/28-11/4, CAD s/p stenting.
He presented with dizziness and TIA symptoms. The physical exam showed intact cranial nerve, no muscle power decrease. The echo showed reverse right OA flow velocity may suggest right ICA occlusion. The carotid angiography showed migration of previous two stent.
Relevant test results prior to catheterization
The echo showed reverse right OA flow velocity may suggest right ICA occlusion.
The carotid echo showed stent in situ.
Relevant catheterization findings
Carotid angiography the right internal carotid artery: Atherosclerosis with diffuse severe ISR 80-95% and a new 90% segmental stenosis at distal ICA The migration and shorten of previous two stent
Vascular approach: Right femoral artery
2) Guiding catheter: JR4 (7Fr.)
3) Guiding wire: Terumo wire to CCA orifice; then ““Fielder”” wire to distal ICA
4) The Spider filter wire (3 mm) could not pass through the distal branch initially and the Boston Emerge balloon(2.0/30 mm) to dilate distal ICA with 6 bars; the filter wire could pass for protection after dilatation
5) The Multi-Link Stent(3.0/38 mm) was deployed at right distal ICA new stenosis and the balloon of stent (3.0/38 mm) to dilate for post-stenting dilatation
6) The Boston Sterling balloon (5.5/20 mm) was used to dilate proximal to distal ICA with 6-12 bars
7) ““Carotid Wall stent””(7.0 mm/50 mm) was deployed at proximal to distal ICA and the Boston Sterling balloon (5.5/20 mm) for post-stenting dilatation 14 bars.
We presented a case of delayed Shortening and restenosis of Carotid Wall stent.
We have some hypothesis of this phenomenon: 1. Marked mismatch of diameters between CCA and ICA 2. Elastic recoil of the tortuous carotid artery 3. Carotid wall stent is a closed cell type with self-expanding design.
There is also some lesson we can learn from this case: 1. Although carotid echo showed moderate stenosis, we can arrange Ophthalmic echo for evaluation of ICA stenosis. 2. We may use IVUS for evaluation of diameter of vessel and choose the correct size stent. How much distance should we overlap?