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

• 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

Microcatheter run

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

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Run post Angioplasty x2

Protégé stent 10x40mm

Telescoped another Protégé stent 10x40mm

Checkpoint

Before

After

Viatrac 14 Plus Balloon 5x20mm

AngioJet x2

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Before/After AngioJet

Intravascular Ultrasound (IVUS)