Bilateral carotid artery stenosis

Bilateral carotid artery stenosis Bilateral carotid artery stenosis can be treated by carotid stenting. Bilateral carotid artery stenting, if done carefully and as a staged procedure has a low risk. Avoid those with TIA within 2 weeks / recent stroke and those with thrombus as they have a high risk of embolisation. Usually carotid stenting is done as a staged procedure to prevent hyperperfusion syndrome. Lesions at or above C2 and below the clavicle are not amenable to surgery and are taken up for carotid artery stenting. Same is true of severe comorbidities. Stenting is seldom undertaken if there is large ipsilateral neurological defect. Lesion length more than 3 cm and presence of clots are predictors of high risk. Head hunter catheters with various curve sizes are useful for carotid interventions. Marked tortuosity makes positioning of the distal protection device difficult. Filters should be oversized by 2 mm compared to the distal internal carotid artery. Predilatation is done only if the lesion is very tight, of the order of 99%. Most of the embolisation occurs during post dilatation and distal protection devices are mandatory. Since most of the stents are self expanding, the lumen may increase over time after implantation as documented often by repeat angiography at a later date. Collateral damage is less likely with incidental external carotid occlusion as there is good collateral flow for the external carotid territory. If the basket gets filled with debris, use of a...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Angiography and Interventions Bilateral carotid artery stenosis Bilateral carotid artery stenting Bilateral carotid stenosis Carotid stenting hyperperfusion syndrome predictors of high risk risk of embolisation Source Type: blogs