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Recanalization of symptomatic chronic ICA occlusion using Angioplasty, Stenting, and Rheolytic Thrombectomy

Last update on February 16, 2024

Embark on the journey of a 75-year-old male with transient neurological symptoms and a history of cardiovascular disease, undergoing intricate endovascular intervention for an occluded left internal carotid artery. Witness the meticulous steps involved in recanalization, showcasing the unique challenges of managing recurrent large vessel occlusion refractory to medical treatment.

Case presentation
  • 75 yo male with slurred speech, aphasia, and left eye blurry vision
    • Resolved spontaneously within few minutes
  • Hx of HTN and CAD with cardiac stents
  • CT head: no intracranial abnormalities
  • CTA head and neck: no LVO; occluded left ICA at the origin
  • CTP: large area of perfusion deficit with increased Tmax in the left MCA and PCA distribution

 

Equipment used

  • Femoral access
  • Guide cath: 6F Neuron Max 088
  • Diagnostic cath: 5F Penumbra Simmons 2
  • Microwire: V-18 (018); Whisper wire 014
  • Microcath: Prowler Select Plus 021
  • EPD: Spider 5mm
  • Balloon / Stent / AngioJet device

 

First run

First run (AP)
First run (Lateral)

 

Crossing with V18 wire

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Advancing microcatheter

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Microcatheter run

Microcatheter run

Embolic protection device (Spider 5mm) advanced over 014 Whisper wire

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Viatrac 14 Plus balloon 4x40mm (x2)

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Run post Angioplasty x2

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Protégé stent 10x40mm

Protégé stent 10x40mm
Protégé stent 10x40mm

 

Telescoped another Protégé stent 10x40mm

Telescoped another Protégé stent 10x40mm
Telescoped another Protégé stent 10x40mm

 

Checkpoint

Before

Checkpoint - Before

After

Checkpoint - After

 

Viatrac 14 Plus Balloon 5x20mm

Viatrac 14 Plus Balloon 5x20mm

AngioJet x2

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Before/After AngioJet

After AngioJet

 

Intravascular Ultrasound (IVUS)

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IVUS Before/After

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LINNC Paris 2025 LINNC China 2025 LINNC Seminar 2025 - Asia Edition LINNC Seminar 2026 - Americas Edition