Staged Recanalization Of Carotid Artery Occlusion Paul Hsien-Li - - PowerPoint PPT Presentation

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Feb 04, 2024 662 likes •990 views

Staged Recanalization Of Carotid Artery Occlusion Paul Hsien-Li Kao, MD Associate Professor Cardiac Cath Lab Director National Taiwan University Hospital Cardiovascular Center Paul HL Kao 12 Disclosure Statement of Financial Interest I,

SLIDE 1

Staged Recanalization Of Carotid Artery Occlusion

Paul Hsien-Li Kao, MD Associate Professor Cardiac Cath Lab Director National Taiwan University Hospital

Cardiovascular Center

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SLIDE 2

Disclosure Statement of Financial Interest

I, (Paul Hsien-Li Kao) DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

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SLIDE 3

Case history

80y man with minor stroke in 2011-7
HTN with adequate medical control
Neck Duplex showed LICAO
CTA in 2011-10 confirmed LICAO, with

abnormal CTP

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SLIDE 4

CTA 2011-10

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SLIDE 5

CTP 2011-10

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SLIDE 6

Treatment planning

EC/IC bypass was refused
EC4V with recanalization attempt scheduled

in 2011-11 after informed consent

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SLIDE 7

Bilateral VAs

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SLIDE 8

Patent RICA with cross-filling

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SLIDE 9

LICAO

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SLIDE 10

Distal ICA via OA

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Recanalization strategy

Femoral approach with 8FJR4 GC
Coronary hydrophilic wire followed by CTO

wire, with micro-catheter support

Once wired through, exchange to spring-coil

tip wire

Small profile coronary balloon dilatation
Stent deployment (with/without embolic

protection) as indicated

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SLIDE 12

Initial wiring

Fielder FC in Finecross Conquest Pro in Finecross

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SLIDE 13

Finally wired into OA

Fielder FC in Finecross Fielder FC in Finecross

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Confirmed

Finecross injection Sion in MCA

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SLIDE 15

Small-size ballooning

1.5mm Ikatzuchi 2.0mm Ikatzuchi

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Yeahhh….oops

CC fistula!!

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Now what?

Patient totally asymptomatic
Transfer to ICU for observation
Reverse heparin, maintain lower BP
Discharged 1 week later without any

complaint or sequela

Follow-up CT 1 month later if stable

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SLIDE 18

CTA 2012-1

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SLIDE 19

CTP 2012-1

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SLIDE 20

Staged CAS in 2012-2

Confirm resolution of CC fistula
Proximal embolic protection
Self-expanding stent for cervical ICA and

balloon expandable for distal lesion

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SLIDE 21

Cervical LICA

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LICA IC

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SLIDE 23

MoMA protected wiring

8F MoMA Sion

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SLIDE 24

Wall stent and aspiration

7x50mm Wall stent dilated with 6mm Sterling and aspiration

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SLIDE 25

Tsunami for distal ICA

3.5x20 Tsunami stent

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MoMA released

SLIDE 26

Final cervical LICA

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Final LICA IC

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Clinical course

ICU overnight observation without any event
Discharged 2 days post procedure
DAPT
Clinical follow-up without any complaint up

till now

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SLIDE 29

CTA 2012-4

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SLIDE 30

CTP 2012-4

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SLIDE 31

Conclusion

CAO recanalization is feasible and improves

cerebral perfusion, but requires specialized techniques and devices

CC fistula can be self-limiting if managed

correctly

MoMA is the device of choice for long ugly

ICA lesion

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