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Tianjin First Center Hospital Lu Chengzhi Guo qianyu Chen xin 天津市第一中心医院心内科 卢成志 郭倩玉 陈欣

Thrombus Aspiration and Sequential Stenting in Bilateral Carotid Arteries for a Patient with Takayasu Arteritis. Tianjin First Center Hospital Lu Chengzhi Guo qianyu Chen xin 天津市第一中心医院心内科 卢成志 郭倩玉 陈欣. History. Female ， 36 years old

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Tianjin First Center Hospital Lu Chengzhi Guo qianyu Chen xin 天津市第一中心医院心内科 卢成志 郭倩玉 陈欣

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  1. Thrombus Aspiration and Sequential Stenting in Bilateral Carotid Arteries for a Patient with Takayasu Arteritis Tianjin First Center Hospital Lu Chengzhi Guo qianyu Chen xin 天津市第一中心医院心内科 卢成志 郭倩玉 陈欣

  2. History • Female，36 years old • Chief complaint: intermittent amaurosis for one month, arose from exertion, accompanied with tumbling • Past history: Takayasu arteritis and pulmonary fibrosis for 3 years under oral prednisone management

  3. Physical Examination • RUE/LUE pulseless, LLE pressure 170/80 mmHg, RLE pressure 130/80 mmHg • III/6 systolic murmurs in left carotid artery. Both lung clear. HR 72 bpm，regular rhythm, no murmurs.

  4. Laboratory Investigations • Blood Rt：Hb 110g/L WBC6.1X109/L • Liver function and renal function: normal • TC 6.31mmol/L TG 1.64mmol/L • ESR：18mm/h • CRP： 0.76mg/dl • Immune antibodies： SSB(+) SSA(+) ANA: 1：100 others:(-)

  5. Auxiliary Examinations • ECG：normal • UCG: normal

  6. Angiography Examination • CAG：40% stenosis in LM ostium LAD normal LCX normal RCA normal • Ceberal angiography:： Brachiocephalic trunk occlusive. Left carotid artery subtotal occlusive. Left subclavian artery: 90% stenosis left vertebral artery: 95% stenosis in ostium

  7. Left carotid artery subtotal occlusive Left subclavian artery: 90% stenosis left vertebral artery: 95% stenosis in ostium Brachiocephalic trunk occlusive

  8. Treatment strategy • Conservative therapy? • Interventional therapy? • Carotidendarterectomy?

  9. Treatment strategy • Medication：prednisone cyclophophamide • Interventional therapy： first step: stent in right carotid artery second step: stent in left carotid artery

  10. Stenting in right carotid artery（2009-05-25） • Approach：right femoral artery • Equipment： 8F MPA1 Guiding catheter guide wire distal end protective umbrella 2.0×20mm×mm Avion balloon thrombus aspiration catheter 5.0×40mm Submarine balloon 7.0×40mm Precise stent

  11. 2.0×20 balloon dilation After dilation

  12. Distal end potective unmbrella 5.0×40mm balloon

  13. After thrombus aspiration before aspiration Thrombus

  14. 7.0×40 Precise stent Post dilation

  15. Final result

  16. Postoperative treatment • Aspirin 300 mg and clopidogrel 75 mg • Nifedipine to control BP • Prednisone • The patient’s ESR rose transiently and then fell normal, she didn’t feel dizziness or amaurosis any more.

  17. Stenting in left carotid artery（2009-06-22） • Approach：right femoral artery • Equipment： 8F MPA1 Guiding catheter 2 guide wire 2.0×20mm×mm Invatec balloon distal end protective umbrella 5.0×30mm Invatec balloon 7.0×40mm Cordis stent

  18. right carotid artery Before operation 2.0×20mm×mm Invatec balloon

  19. 5.0×30mm Invatec balloon 7.0×40mm Cordis stent Final result

  20. Discussion • Endovascular interventional therapy: an approach to occlusive lesion of arteritis: Is it a suitable option? • Thrombus aspiration: the first attempt dealing with thrombotic complications of stenting in carotid: Is it a lucky hit or a mandatory practice? • medication or stenting in subclavian artery: Is it done or overdone? • Antiplatlete therapy: duration and dosage.

  21. Follow up • No dizzness or amaurosis until now • ESR 15-25 mm • Medication: prednisone 5 mg QD Aspirin 100 mg clopidogrel 75 mg QD for 6 Months • 8 month later CTA examination

  22. 8 months later CTA show restenosis Stent in right carotid artery

  23. Stent in left carotid artery

  24. Discussion • What to do with restenosis now: Intervention: bilateral balloon dilation? Conservative treatment? Carotidendarterectomy?

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