PROCEDURE
A 9Fr sheath was placed in the right femoral artery and a 4Fr sheath in the right femoral vein. The position of the femoral vein had been confirmed beforehand using ultrasound. A 9Fr Optimo catheter was advanced into the right common carotid artery, taking care to avoid passing the wire through the stenotic segment. An Optimal wire was advanced into the right external carotid artery, and the balloon was advanced distally beyond the superior thyroid artery. The stenotic segment was wider than anticipated, making guidance easier. The balloon was inflated, making visualization difficult during expansion. Expansion also took considerable time. To achieve complete occlusion of the external carotid artery, the balloon required full expansion. The Optimo balloon was expanded, inducing flow reversal. Complete reflux was not achieved. Flow reversal was subsequently maintained. There was some slight movement, but the patient tolerated ischemia well. Pre-dilation was performed with a 3mm balloon, followed by stent placement. Post-dilation was performed with a 4mm balloon. After passing through and dilating the stenotic segment, blood was aspirated to remove debris. When withdrawing the guidewire, I felt it catch on the stent, but the stent did not dislodge. The stent was positioned slightly distally but was well-placed. The technician remarked, “It’s textbook perfect placement. However, if it had been even slightly more distal, we would have needed to place another stent over it.” Internally, I thought, “Shut up,” but I replied, “I also think so. It’s in a good position.” The postoperative head MRI showed no new cerebral infarcts, which gave me considerable confidence.
TIMELINE
12/15 DAPT
12/31 Admission
1/1 CAS
1/2 MRI
2/1 MRI
3/1 SAPT, sonography.
WILLPOWER MELTDOWN SOMETIMES 