TJWY's Proender® Disposable Embolic Protection Device in the Treatment of Carotid Stenosis

Recently, Prof. Lu Xiaobo from Taizhou Second People's Hospital treated a case of carotid artery stenosis with Proender® Disposable Embolic Protection Device

Physician’s summary

The target zone of the Embolic Protection Device is the distal end of C1 segment of the internal carotid artery, which is about 4 cm away from the lesion, so as to avoid vasospasm caused by a large distance and stent implantation affected by small distance.

If it is difficult to deliver the recovery sheath of Proender®, the recovery sheath can be smoothly recovered by adjusting the guiding position and angle of the headend so that a space can be formed between the recovery sheath and the stent.

The design of an independent guide wire in the Proender® Disposable Embolic Protection Device is helpful to reduce pulling to the filter when the stent is implanted later, so as to avoid vasospasm cause by the movement of filter to the greatest extent. The larger recovery sheath in the cavity is designed so that the filter can be recovered more smoothly and conveniently.

Patient Information

• Male, 63Y.

• Complaint: Paroxysmal left limb weakness for more than 1 month.

• History of present illness: The patient was hospitalized three times due to paroxysmal left limb weakness within 1 month.

• History of past illness: History of diabetes and hyperlipidemia. Smoking for over a decade.

Pre-operative imaging

• DSA: R-ICA severe sinus stenosis.

Procedure

• After sheath delivery through puncture under local anesthesia, deliver the 8F guide catheter at the lesion near R-CCA, select TJWY’s TJEP05 Disposable Embolic Protection Device as the distal protective device, carefully pass the guide wire and delivery sheath through the C1 segment stenosis of internal carotid and take the flat area at the distal C1 segment of internal carotid as the target “landing zone” of the Proender. After the Proender and the guide wire were delivered to the “landing zone” quickly, withdraw the delivery sheath to liberate the Proender, whose position should be kept unchanged during the release process.

• Select an appropriate stent according to the characteristics of lesion structure; after pre-dilating the lesion with a 4*30mm balloon, push the 6-8*40mm open-ring carotid artery stent to the stenosis and slowly release it after accurate positioning.

• After stent liberation, the residual stenosis rate was less than 40%, the stent adhered well, and there was no local thrombosis in the stent. At the same time, observe the position of the Proender, and there was no vasospasm or contrast agent retention.

Angiography after stent liberation

• Withdraw the Proender, it is found that it is difficult to recover the recovery sheath when pushing the recovery sheath through the stent. After adjusting the guiding position and the angle of the headend, the recovery sheath passed smoothly, so that the marker at the headend of the recovery sheath overlapped with the marker of the Proender. Hold the Proender guide wire and the recovery sheath, and withdraw them together to finish their recovery.

After operation

• The stent completely covered the plaque; the stenosis was relieved; the angiogenesis was good; the stent adhered well, and there was no local thrombosis in the stent.

Postoperative imaging

Before operation/After operation

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 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.