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Transcript of Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and...
![Page 1: Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.](https://reader030.fdocuments.net/reader030/viewer/2022032313/56649e6a5503460f94b6744e/html5/thumbnails/1.jpg)
Carotid artery stenting for carotid artery stenosis
Dr. Nikolaos Melas, PhDVascular and Endovascular Surgeon
Military Doctor
Associate in 1st department of Surgery, Aristotle University of Thessaloniki, Greece
Associate in Interbalcan Medical Center
![Page 2: Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.](https://reader030.fdocuments.net/reader030/viewer/2022032313/56649e6a5503460f94b6744e/html5/thumbnails/2.jpg)
Preoperative scanning
![Page 3: Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.](https://reader030.fdocuments.net/reader030/viewer/2022032313/56649e6a5503460f94b6744e/html5/thumbnails/3.jpg)
Carotid Triplex high grade stenosis of internal carotid artery
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MRA (magnetic res angiography)
![Page 5: Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.](https://reader030.fdocuments.net/reader030/viewer/2022032313/56649e6a5503460f94b6744e/html5/thumbnails/5.jpg)
Digital subtraction angiography (DSA)
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CT csan
Μικροέμφρακτα βασικών γαγγλίων άμφω
![Page 7: Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.](https://reader030.fdocuments.net/reader030/viewer/2022032313/56649e6a5503460f94b6744e/html5/thumbnails/7.jpg)
MRI (magnetic res. imaging)
Huge right hemispheric infarct
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Carotid stenting procedure
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1st case
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Initial angiographysevere internal carotid kinking (red arrow)
High grade ostial stenosis in internal carotid artery (κίτρινο βέλος)
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Initially Cerebral protection device is deployed
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Pre stenting angiographythe yellow arrow shows the stenosis to be dilated
![Page 13: Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.](https://reader030.fdocuments.net/reader030/viewer/2022032313/56649e6a5503460f94b6744e/html5/thumbnails/13.jpg)
Stent deployment
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Post deployment we dilate the stent with a balloon
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The stent is fully deployed
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The carotid artery is now patent without residual stenosis. The kinking has not changed.
Initial angiography
Operative time 10 min
Final angiography
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Crossing the lesion Cerebral protection filter
Stent deployment and balloon dilatation
Filter removal
Basic steps in carotid stenting
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2nd case
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Initial angiographysevere internal carotid kinking (red arrow)
High grade, long in length stenosis in internal carotid artery (κίτρινο βέλος)
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Difficulty to pass the stent from the stenosis
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Pre dilation with coronary balloon 3 χ 12 mm
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Stent deployment (SE 6-8 x 40 mm)
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Post deployment dilation with 5 Χ 30 mm balloon
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Angiography after first post dilationthere is still a residual stenosis (red arrow)
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2nd post dilation
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Final angiography
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CASE 3
Post stenting
Prior to stenting
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CASE 4
Prior to stenting
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CASE 5Post stenting
Prior to stenting
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CASE 6
Prior to stenting
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CASE 7
Post stentingPrior to stenting
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CASE 8Prior to stenting Post stenting
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CASE 9
Prior to stenting Post stenting
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CASE 10Prior to stenting Post stenting
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CASE 11
Post stentingPrior to stenting
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CASE 12
Post stentingPrior to stenting
![Page 37: Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.](https://reader030.fdocuments.net/reader030/viewer/2022032313/56649e6a5503460f94b6744e/html5/thumbnails/37.jpg)
CASE 13Post stentingPrior to stenting
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CASE 14
Post stenting
Prior to stenting
![Page 39: Carotid artery stenting for carotid artery stenosis Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department.](https://reader030.fdocuments.net/reader030/viewer/2022032313/56649e6a5503460f94b6744e/html5/thumbnails/39.jpg)
CASE 15
Post stentingPrior to stenting
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CASE 16
Post stentingPrior to stenting