EXPERIENCE WITH MER SELF- EXPANDIBLE STENT IN CAROTID STENOSIS TREATMENT.
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1 EXPERIENCE WITH MER SELF- EXPANDIBLE STENT IN CAROTID STENOSIS TREATMENT. FIC Warsaw. 23/06/2017 JOSÉ M. NAVASA MELADO. Ph RADIOLOGY. HU. MARQUÉS DE VALDECILLA.
2 ! UH. Marqués de Valdecilla. Santander. Cantabria. Spain.! Neuroradiology. BACKGROUND.! Neurointerventional surgery department.! Neurovascular unit: NRx (Dr. González Mandly), Neurology ( Dr. Palacios, Dr. Vázquez, Dra Revilla.), Vascular surgery ( Dr. García). UARH ( Dr. Tejido).! Cantabria: 600,000h. Population. ( 1,2 m summer).
3 NUMBERS.! Distribution 55-45%. Surgery. - Faster. - Anatomical conditions. - Patientś decision.! 55 PTA Scheduled and emergent.! 2-3 days on charge.
4 MER DEVICE.! BALTON.! Open-cell Z Shaped hybrid design.! Nitinol stent.! Laser-cut.! Pull-off / Twist-off deployment system.
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6 MER DEVICE.! Excellent pushability and trackability.! Exceptional flexibility.! High radial forze.! Fatigue resistance.! Tapered or straight design.! Eight Platinum markers at both ends of the stent.! Optimal biocompatibility (low scores for inflammation and damage of the arterial wall).! Complete endothelialization.
7 MER DEVICE.! As advantages: - Better adaptation to vessel even in complex lesions. - Plaque stabilization with reduction of the risk of embolism.
8 NUMBERS. MER.! February 2015-May 2017.! 56 MER: - 35 stents 6-8x40 mm. - 8 stents 5-7x40 mm. - 4 stents 5-7x30 mm. - 1 stent 7x40mm. - 6 stents 6-8x30 mm. - 3 stents 6-8x50mm. - 6 telescoped: MER, Wallstent, Acclino, Solitaire.
9 BASELINE CHARACTERISTICS.! 55 patients.! Age y.! Median age 65.! 87% Male.! 60% Right carotid stenosis.! 18% Acute phase.! 15% Associated other treatments.! 10% reestenosis.! 90% Symptomatic.
10 TECHNIQUE.! Conscious sedation. GA.! Local anesthesia.! Aproach femoral/humeral.! Short sheath 6F.! Guide Catheter 0,071 ( Envoy 6F, Cello 8F).! Microwire 0,014.! NEVER EMBOLIC PROTECTION DEVICES.! Pre y Postdilatation ( 3mm y 5/6mm).! Heparine ev procedure. Dual antiplatelet pre and post-treatment.! Heparine reversion and suture.
11 COMPLICATIONS.! Groin hematoma: 5 patients.! Hyperperfusion: 2 patients. ( 1 dies).! TIA: 1 patient.! Bradycardia: 8 patients ( 4 symptomatics).
12 CASES.! Case 1: - 72 yo male. - HTA, DLP, SCASEST COPD. - Right hand palsy. TIA. - AngioCT: stenosis 90%. Left carotid A. - Conscious sedation. - MER 6-8/40mm.
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17 Case 2.! 56 yo male.! HTA, DLP, DM, CPOD.! Pulmonary neoplast ChT+RT.! Amaurosis fugax limb shaking.! Left ICA 85% stenosis.! Local anesthesia.! 6-8X40mm.
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19 CASE 3.! 64yo male.! HTA, DLP, DM. smoker.! Left middle cerebral artery acute stroke: - Dysarthria, facial palsy, dysphasia, hemipalsy - NIHSS h evolution. AngioCT Left internal CA occlusion. RtPA and mechanic tretament. General anesthesia.
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26 ! Neuronmax 0,88.! Pre y postdilatation ( 3 y 6mm).! Nasogastric sondage.! 450 mg Inyesprin ev y 300 mg clopidogrel +100 SSF SNG.! 30 mins.! Wakes up with clinical improving.! Discharged 3 days later with mild Dysarthria.! 6 months: asymptomatic. Sonography with no residual stenosis.
27 CASE 4.! 57 yo male.! SAH blister like right V4.! Ventricular derivation. Treatment with flow diversion.
28 CASO 4.! Varón de 57 años.! HSA blister like V4 derecha.! DVE. Tratamiento con flow diverter.
29 CASO 4.! One week later difuse vasoespasm. Refractary to non invasive techniques.! GA.
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36 ! Never improved.! Difuse malignant infarction.! Dies 4 weeks later.
37 CASE 5.! 67 yo male.! Smoker, OH, HTA, DLP, DM. Ischemic Cardiopathy.! Transient left hand dishability and instability.! AngioCT: Left ICA critical stenosis and 60-70% on right ICA.! We decided to treat symptomatic vessel.! Local anesthesia.
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40 CASE 6.! 63 YO female.! Right hemispheric stroke in 2011.! Along last year right ICA stenosis progression! 90%.! Local anesthesia.
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44 CASE 7.! 60 yo male.! Left TACI. NIHSS h evolution.! ASPECTS 8. AngioCT tandem occlusion.! Combined treatment.! GA.! 8F.
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52 ! Inyesprin 450 ev.! 300mg Clopidogrel Nasogastric.! MER 6-8x40 and post 6mm.! At discharge 5 days later: - Walks with assistance. - Dysphasia. - Mild dysartrhia.
53 CONCLUSIONS.! Mixed quality device.! Excelent adaptation.! Other devices.! Low profile.
54 Thanks.
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