Hemodynamic disturbance necessitating acute carotid artery stenting

Recorded cases from SLICE 2018

2 october 2018 – 13:30

By Vincent COSTALAT

Taking the time to intervene well

Three hours after symptoms onset, a 56-year-old male suffering from what was first described as a mild stroke enters the local hospital and is seen to have a more complex clinical situation. An M1 stroke, an M2 occlusion as well as an occluded internal carotid artery (ICA) – How to proceed?

Join Prof. Vincent Costalat as he presents a case which challenged, not only the operator, but the expert panel as well. Learn about the complexity of treating “mixed” hemodynamic and embolic lesions. Discover the components involved in decision-making and why you can take more time with late-presenting patients with low NIHSS scores. Learn about the use of “perfusion mapping” and 3D imaging.

What are the challenges faced in performing MT when lithics have been administered? Why would aspiration, de-bulking the lesion – and not treatment – be an important first step. Would you use a distal filter? What should concern you? In-stent occlusions? Calcification? Reopro or aspirin? Clots? Necrotic core infarction? What would be the “threshold of risk” and should we be aggressive in the brain, but not in the neck in terms of stenting the vessel? How much do we really know about acute carotid artery stenting and how hard is it for an interventionalist to say they can’t go on? Find out here…

 

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