55 years old patient a known case of coronary artery disease, hypertension, and diabetes mellitus type II presented with recurrent right hemiparesis with three similar episodes in the past. She had right spastic hemiparesis more in upper limb than a lower limb. On examination patient was conscious, alert and oriented, pulse 88/min, regular, Blood pressure 146/90 mm of Hg, Power in right upper limb and lower limb was 4/5.MRI brain revealed left middle cerebral artery infarcts and critical stenosis of the left Internal Carotid artery.
A carotid angiogram was done which showed, right ICA mild disease, left ICA shows 95% stenosis with ulcerated plaque. After informed consent, the left carotid artery was cannulated with JR 5F diagnostic catheter and exchanged with 7F Shuttle sheath with the help of extra stiff 0.032’’ guidewire. Then left ICA lesion was crossed with 0.014” x 180 cm run through the wire and Spider FX 6 mm filter was positioned in the distal internal carotid artery. Pre dilatation did with 3 x 20 mm maverick balloon after premedication with atropine. Later 6-8 x 30 mm tapered Xact stent was deployed across stenotic lesion with good result. The post stent angiogram did not show any distal embolisation. At the time of discharge, right upper limb power 4/5 and Lower limb power 4/5. Carotid artery stenting can be done successfully for indicated patients.
Dr. Manoj Kumar Agarwala, MD, DM, FACC (Consultant Cardiologist)
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