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A 73-years old female with history of previous left carotid endarterectomy and recent acute transient ischemic attack was referred to our Center to undergo carotid stenting. Her Duplex ultrasound showed severe left internal carotid artery restenosis with significant Doppler flow acceleration.
A 79-year-old diabetic male patient with no history of coronary disease is referred to you to undergo angioplasty for tissue loss on the tips of the hallux and second toe. He is taking Aspirin 75mg. From preoperative imaging he needs a 20cm SFA occlusion stopping before the adductor hiatus recanalizing as well as multilevel tibial disease which appears to be a combination of short occlusions and stenoses. The dorsal pedal is seen in the foot and is in continuity with the arch. The PT artery appears occluded through it’s whole length.
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Carotid artery stenting is a delicate surgery being sometimes as fast as insidious.
We strongly believe that in order to minimize complications rate an almost obsessive attention to details in each procedural moment is essential.
In this video we report probably the most standardized procedure performed at our institution with 6 operators currently doing each passage exactly the same way.
Of course we don’t claim to show the way it should be done, but just the way we learned to do it after more than 3000 performed cases
TCAR is a hibryd option for CAS offering the best cerebral protection with reverse flow system engaging the common carotid artery with the contralateral common femoral vein. The Roadster Trial has the best data never published regarding Peri-operative neurological events for a prospective multicentre Trial. The procedure could be perform under local anesthesia with the patient copletely awake.
Dr. Giovanni Tinelli presents a very comprehensive overview regarding the treatment of the vascular trauma of upper limbs. His presentation includes all relevant information about definition and anatomy, classification of the injury, the different types of treatment and tips from his personal experience.
Clinical Summary
– 28 year old male
– Traumatic aortic injury (TAI)
– Endovascular treatment
Complications
– Aortic arch and brachiocephalic trunk dissection
– Right carotid artery and left sublcavian artery occlusion
– Stroke
– Orthostatic Hypotension (Extracranial Steal Syndromes from Disease of the Aortic Branches?)
Surgery Technique
– Femoro-femoral and right axillary artery cannulation
– The aorta was accessed through a Ministernotomy
1. The heart is accessed through a full midline sternotomy
2. An off-pump coronary artery bypass graft is performed on the left anterior descending artery using a saphenous vein graft and 7-0 prolene continuous suture
3. The aorta is partially clamped with a side clamp and is opened through a longitudinal incision, about 2 cm length
4. A prosthesis is sutured onto the aorta with a continuous 4-0 prolene suture
5. One branch of the prosthesis is passed behind the ascending aorta,
Patient’s characteristics
Gender: Female
Age: 72 years old
Comorbidity: Arterial hypertension, hypercholesterinemia, previous smoker
Symptoms: None
Previous operations: None
Vascular Imaging of the left internal carotid artery: Duplex ultrasound with peak systolic velocity (PSV)> 230 cm/sec
This is a recorded case presenting all the important steps of carotid artery stenting (CAS). These steps include the use of transbrachial access, the advancement of the sheath in the common carotid artery, the placement of the Mo.Ma cerebral protection device to remove all sizes of debris and the final procedure of carotid artery stenting. Finally, the interventionalists demonstrate all relevant aspects of intraoperative monitoring by transcranial doppler.
This case report demonstrates the bidirectional endovascular treatment of a severe calcified CTO of the brachiocephalic trunk and the right common carotid artery
This is an overview of the current techniques and devices and the respective level I evidence regarding the endovascular treatment of acute ischemic stroke. Moreover, this presentation includes a case example with all important steps (admission to the hospital > diagnosis > endovascular treatment > recovery) of a 16yr old female patient with an acute ischemic stroke.
