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Case Sharing: Proender® Disposable Embolic Protection Device for the Treatment of Multiple Internal Carotid Artery Stenosis

Case Sharing: Proender® Disposable Embolic Protection Device for the Treatment of Multiple Internal Carotid Artery Stenosis

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Position: Right internal carotid artery, Right vertebral artery, Left internal carotid artery, Left vertebral artery.

Surgery: Remote protection in stent implantation

Features: Efficient capture, Independent guidewire structure, Convenient exchange

 

 

Patient Information

• Male, 79 years old

 

Pre-operative imaging

• DSA Result: multiple severe stenosis in the C1 and C4 segments of the right internal carotid artery, severe stenosis at the initial segment of the right vertebral artery, multiple mild to moderate stenosis in the left internal carotid artery, and occlusion of the left vertebral artery.


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Procedure

• After the puncturing of femoral artery under the guidance of the intraoperative road map, the guide wire was inserted to bring the sheath of protection device through the diseased site to the distal end of the right C1 segment. The TJEP05 protection device was released. The opening of protection device was well-defined under DSA angiography, and the markers were clearly visible. The stenosis was slightly improved after balloon dilation. There was a partial dissection in the C1 segment, the intracranial segment of the internal carotid artery was slightly poorly developed, and there was a suspicious filling defect in the protection device.


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• The patient developed yawning and irritability, suggesting cerebral ischemia. One stent was immediately in the stenosis of the C1 segment. Re-examination showed that the blood flow was improved, and there were some filling defects in the protection device. The protection device was withdrawn at once. The process went smoothly. In the subsequent observation, a mass of fresh thrombus was seen in the protection device.


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• After the patient's symptoms disappeared, the stent was inserted into the C4 segment along the guide wire, and then released after sufficient nominal pressure filling. There was no obvious residual stenosis, and the distal branch was good.


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• After making the micro-guide wire cross the right V1 segment to the distal end of the V2 segment, the pre-expanding balloon was placed into the expandable stent, and released after sufficient nominal pressure filling. There was no obvious residual stenosis. The distal branch was good. The patient had no discomfort and the operation was finished.


Product Description 


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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.


References:

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[2] Wu Ting, Gong Lisha. The nursing experience of 6 cases of acute ischemic stroke treated with alteplase thrombolysis [J]. Today Nurse (First Issue), 2018; 25(3): 55-6.

[3] Lv Chenling. The correlation between ADAMTS-1 gene polymorphism and acute large atherosclerotic cerebral infarction [D]. Wenzhou: Wenzhou Medical University, 2015.

[4] Wu Chengying, Li Hongmei. Screening methods and analysis of prevention and treatment for high-risk populations of stroke in the community [J]. Electronic Journal of Clinical Medical Literature, 2019; 6(16): 171.

[5] Shao Jianwei, Zhou Wei, Ni Tongtian, et al. The relationship between carotid atherosclerotic plaque and neurological deficits in patients with acute cerebral infarction [J]. Chinese Journal of Medicine, 2018; 53(8): 907-10.

[6] Izza DAT, Ricciardelli C, Russell DL. The metal loproteinase ADAMTS1: a comprehensive review of its role in tumorigenic and metastatic pathways J.Int J Cancer,2013;133(10):2263- 76.

[7] Ye Guifen, Liu Zongyan, Sun Yongmei, et al. Carotid artery color Doppler ultrasound screening and analysis of related risk factors of stroke in high-risk population [J]. Gansu Yiyao, 2017; 36(3): 184-6.

[8] Gao Yu, Lei Xiaochun, Bu Fan. Study on risk factors of stroke in high-risk population in Beijing community [J]. Chinese General Practice, 2013; 16(36): 4261-4.

 

 


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