Patient Information
• Male, 84 years old, weighing 73 kg. Dizziness for two years and worsening for half a month.
Past medical history
• The patient had discomfort in the precordial area, had a history of hypertension, took "clopidogrel, amlodipine, and valsartan/hydrochlorothiazide tablets", denied the history of smoking and drinking.
Pre-operative imaging
• Bilateral internal carotid artery medial uneven thickening with plaque formation, stenosis of the initial segment of the left internal carotid artery. 2. The left atrium was enlarged, the mitral valve and tricuspid valve had mild regurgitation, the aortic valve had mild to moderate regurgitation, and the left ventricular diastolic function was reduced.
Cerebral angiography
• The petrous and cavernous sinus segments of the right internal carotid artery demonstrated about 80% stenosis, and the beginning of the left internal carotid artery demonstrated about 90% stenosis.
Head & neck MR+HRMR
• The C3 and C4 segments of the right internal carotid artery and the beginning of the left internal carotid artery showed enhanced plaques, with severe stenosis of the lumen; the C3 segment of the left internal carotid artery demonstrated local expansion.
Procedure
• Since the patient has cardiac insufficiency and regurgitation and the stenosis in the petrous and cavernous sinus segments of the right internal carotid artery was about 80%, the stenosis at the beginning of the left internal carotid artery was treated first, and the selective operation was scheduled for stenosis in the right internal carotid artery. Then the left carotid artery angioplasty was performed.
• The 6F vascular sheath was placed in the left brachial artery, the 5F catheter was placed in the left carotid artery under the guidance of a 0.035in guide wire, a 260cm hardened guide wire was inserted into the left external carotid artery, replaced the 6F guide catheter. And TJWY Proender® 6mm protection device was inserted through the diseased site and slowly released at the distal end of the stenosis.
• The 3×20 mm and 4×20 mm balloons were expanded at the stenosis segment, and then a drug balloon was expanded by 14 atm and maintained 40s.
After Operation
• After the drug balloon was expanded, the retrieval sheath was returned in position, the protection device was completely pulled back into the sheath, and withdrawn from the body. The postoperative angiography showed that the blood flow is smooth and the stenosis of the diseased blood vessel is significantly improved.
The carotid artery is a large blood vessel that transports blood from the heart to the head, face, and neck. It is one of the major vessels for supplying blood to the brain. The literature reported that patients with severe carotid artery stenosis, even with effective drug treatment and control, had an incidence rate of cerebral ischemia within 2 years as high as 26%. More than 60% of cerebral infarctions are caused by carotid artery stenosis. Severe cerebral infarction can cause disability and even death of the patient. Therefore, carotid artery stenosis has become one of the "top killers" that endanger people's health in today's society.
Extracranial carotid artery stenosis is mostly caused by atherosclerosis. Lumen stenosis/occlusion, plaque rupture and embolism can lead to ischemic stroke. The clinical manifestations from mild to severe are: transient ischemic attack, dizziness, blackout, memory loss, hemiplegia, aphasia, etc. As a minimally invasive interventional method for the treatment of carotid artery stenosis, percutaneous angioplasty has achieved clinical results similar to traditional carotid endarterectomy, and has the advantages of less trauma and faster recovery.
TJWY Proender® protection device uses nickel-titanium woven filter. The gradual mesh, combined with the seaming design of the mesh, not only can ensure the full opening of the protection device and enhance the attachment effect to trap emboli effectively, but also can reduce the intravascular pressure effectively to achieve double protection of intracranial blood vessels and tissues.
Except for the markers at both ends, the design of the development ring at the opening of the protection device makes it possible to clearly observe the positioning and release status of the protection device during the operation.
The independent guide wire can rotate and move axially in a specific range, which prevents the filter from displacement, and protects the vessel wall from trauma. The fixed sheath is processed by laser spiral cutting, which improves its flexibility, and makes it more conducive to passing through tortuous blood vessels, and more adherent to the wall when the protection device is released.
Delivery sheath provides gradient hardness, and the softer distal segment ensures outstanding kink resistance. Retrieval sheath provides larger inner lumen size. By coating with PTFE inside, the friction is only 50°% of similar products. Integrated sheath for delivery and retrieval is compatible with 0.014" guide wire, which could achieve rapid exchange during the procedure.
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