Emerging trends............

Carotid Angioplasty & Stenting (CAS) in a 68 years gentleman suffering from TIA and RICA near total occlusion

This 68 years gentleman a known hypertensive and having coronary artery disease presented with recurrent TIA involving his left upper limb. He suffered many transient episodes of weakness of left arm over past two weeks. He was treated with systemic heparin during some of these episodes by his treating physician. On MRI brain, he demonstrated small lacunar infarcts in bilateral centrum semiovale. MRA of brain vessels, in neck portion revealed total occlusion of RICA just at the RCCA bifurcation. His left Internal Carotid Artery was 70% stenosed. When he was referred to us for carotid angioplasty stenting(CAS), he was neurologically intact and was living an active independent life. We performed Cerebral DSA to evaluate cerebral haemodynamic and understand the risk of stroke and plan CAS if feasible. On Cerebral DSA his RICA was 99% blocked and not 100% and LICA was 70% stenosed. As his symptoms were mainly to left side that means his right cerebral hemisphere was affected due to 99% RICA stenosis, we planned CAS first to right side. We achieved a 100% angiographic and clinical result of CAS(Picture). Patient was discharged from the hospital after 2 days of stay with us. He is now leading a TIA/ stroke free life good quality, independent and active life. This constitutes a good clinical example of disease modification for a good quality of life and modification of stroke risk.

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