Canada Vascular

Cerebrovascular Disease

Background

How Can Carotid Artery Disease Be Diagnosed?

Treatment Options

How Can I Get Screened & Treated for Cerebrovascular Disease?

Common Questions & Answers

Bibliography

 

 


How Can I Get Screened & Treated for Cerebrovascular & Carotid Artery Disease?

How can I get screened?

"Currently The Toronto Endovascular Centre is the only Legs for Life Site In Canada performing Abdominal Aortic Screening at 131 Hazelton Avenue, Ste 102 , Toronto .

Call the Toronto Endovascular Centre at 416-925-2676

Arrange to bring a requisition form for ultrasound from your family physician at the time of your appointment at The Toronto Endovascular Centre"

To print requisition form, click here

How can I get treated for PAD?

Call the Toronto Endovascular Centre at 416-925-2676, to make an appointment with one of our Vascular Physicians. You will require a referral letter from family doctor or specialist.

 

Carotid Stent Case

Dr. S. Kundu BSc, MD, FRCPC, DABR, FASA
Dr. J.M. You MD, FRCPS

Clinical History

64 years old male presented with a 6 month history of intermittent difficulty with speech, and transient numbness every three to four days and transient numbness in right hand. Carotid Ultrasound, echocardiogram, ECG and bloodwork were all negative. Patient referred to speech pathologist and a psychiatrist. After three months patient referred to a Neurologist and a Computed Tomography Angiogram was performed.

Clinical Investigation

Computed Tomography Angiogram demonstrated a severe eccentric Left Common Carotid Stennosis (Fig 1 & 2). Patient was referred for Carotid Stenting as surgery was determined to be a difficult option given the proximal location of the stennosis.

Fig. 1 Fig. 2

Materials and Methods

A Thoracic Aortogram demonstrated the origin of the great arch vessels to be within normal limits. There was a moderate to severe narrowing of the proximal Left Common Carotid Artery (Fig 3). A left cerebral angiogram was within normal limits Cannulation past the stennosis was performed with a .035 Cook Roas Runner Hydrophilic Wire, 5 French Cook DAV 100 cm catheter, and a 5 French Cook Shuttle Sheath. A 6 mm Angioguard Cordis Distal Protection Device was inserted in the proximal left internal carotid artery. A 7 x 40 mm Cordis Precise Stent was inserted at the site of the stennosis (Fig 4). A post stent placement balloon dilation was performed with a Cordis 6 x 20 mm Ameia balloon. Post balloon dilation, the left common carotid artery appeared widely patent (Fig 5 & 6). A left cerebral angiogram was within normal limits. Case performed at Scarborough General Hospital: General Campus.

Clinical Outcome

There was a complete resolution of the patient's symptoms with no further episodes of speech difficulty or numbness.

Summary

Carotid stenting is a viable treatment alternative to carotid endarterectomy in patients with proximal common carotid artery lesions, operative risk factors, post-operative restennosis, and high internal carotid artery lesions.

Fig. 3 Fig. 4 Fig. 5
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