Objective: Proximal balloon protection (PBP) in carotid artery stenting via the transbrachial carotid artery stenting (TB-CAS) approach has not been feasible because a large-sized sheath introducer is required. We report a novel technique of TB-CAS using sheathless balloon guiding catheter navigation. Case presentation: A 76-year-old male presented with a symptomatic left internal carotid artery stenosis. Transfemoral approach was difficult because of severe arteriosclerosis obliterans. A 9Fr Optimo 90 cm was inserted into the right brachial artery over a 6Fr long dilator 108 cm by the coaxial method without sheath introducer, and it was advanced into the right subclavian artery. A long dilator was exchanged with an inner catheter and a 9Fr Optimo was navigated into the common carotid artery by using the telescoping technique. Further procedures were successfully performed by PBP using a 9Fr Optimo. The patient's postoperative course was uneventful, and follow-up head MRI did not reveal any distal embolization. Conclusion: This technique is useful in high-risk patients of distal thromboembolic complication in CAS with difficult femoral access, because it enables PBP by TB-CAS.
Moyamoya disease (MMD) is characterized by progressive occlusion of the internal carotid artery or its terminal branches, associated with formation of extensive collateral vessels (moyamoya vessels) at the base of the brain. Whether unilateral moyamoya disease, confirmed by typical angiographic evidence of moyamoya disease unilaterally and normal or equivocal findings contralaterally, is an early form of definite (bilateral) moyamoya disease remains
Author (year) Case Age /Sex Side Clinical presentation Angiographic finding of M1 Aneurysm Cerebral blood flow Treatment Intraoperative or pathological findings Outcome (hemorrhage) (M1-lesion)
Objective: We report a case of acute cerebral ischemia with tandem lesion in a patient who underwent emergent carotid artery stenting (CAS) and intracranial thrombectomy. Case presentation: A 59-year-old female suffering from aphasia and right hemiparesis was taken in ambulance, 78 minutes later from acute onset. National Institute of Health Stroke Scale was 25. Diffusion-weighted image (DWI) MRI showed acute infarction at left insula cortex, basal ganglia and frontal lobe, and MRA showed left internal carotid artery (ICA) occlusion. Clinical-DWI mismatch was admitted, we performed interventional therapy. DSA showed not only left intracranial ICA occlusion but also left cervical ICA severe stenosis. We placed carotid wallstent at cervical ICA stenosis site. After CAS, we performed thrombectomy for intracranial ICA, and gained complete recanalization. Postinterventional course was uneventful. Right hemiparesis was dramatically improved but motor aphasia was remained at discharge. Conclusion: We reported a case of acute cerebral infarction with tandem lesion leading to improving neurological deficits by CAS and thrombectomy. Interventional therapy for tandem lesion was useful.
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