MORPH Deflectable Catheter Enables Carotid Artery Stenting from Brachial Approach
Dr. Gustav R. Eles
Pittsburgh Cardiac and Vascular Associates
Pittsburgh, PA
Background
A 67-year-old woman with a history of severe bilateral carotid artery stenosis. The patient has a history of multivessel coronary artery disease. The patient had a history of laryngeal malignancy treated with radiation therapy. She was referred for carotid artery stenting due to multiple risk factors including the above as well as severe chronic obstructive lung disease. The left internal carotid artery was stented on October 1, 2003. Three days later the right internal carotid artery was successfully stented. A carotid duplex study performed on September 20, 2005 demonstrated evidence of severe restenosis of the right internal carotid artery and moderate restenosis of the left internal carotid artery. The right-sided velocity was 458/117 cm/s and the left-sided velocity was 325/69 cm/s.
Procedure
Angiography confirmed 80% in-stent restenosis of the right carotid artery and moderate 50% restenosis of the left carotid artery. Multiple guide catheters and guiding sheaths failed to provide suitable access for a redo angioplasty/stent procedure. Ultimately an 8 French 90 cm Morph guide catheter was successfully engaged into the ostium of the right common carotid artery via a right brachial access. The Morph guide catheter provided excellent access which allowed angioplasty and redo stenting to be performed.
Outcome
The patient was discharged the following day uneventfully. By utilizing the Morph guide catheter system we have successfully done three similar carotid stent cases where access via the femoral arteries was not possible.
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