Asymptomatic carotid stenosis stenting

A 60-year-old male with a history of hypertension, dyslipidemia, COPD, coronary artery disease, and former alcohol abuse was referred for evaluation of a significant left carotid stenosis.

Recent imaging confirmed a > 70% stenosis with calcified ulceration in the left internal carotid artery, in the context of diffuse parietal disease and a Type I aortic arch. The patient was on dual antiplatelet therapy and had undergone cardiac arrhythmia ablation three months earlier.

Find out which revascularisation strategy was chosen and how the intervention was safely carried out in this high-risk profile.

Gustavo A. Basso

Leforte Hospital – São Paulo, Brazil

Part I - Case presentation

History

A 60 year-old male patient referred by the cardiologist
No previous TIA / stroke
Hypertension/ dyslipidemia/ heavy smoker - COPD/ CAD, former chronic alcoholic
PO cardiac arrhythmia ablation Dec/24’
Treatment: 💊 DAPT (Aspirin + Ticagrelor) + Statin + 4 classes of antihypertensives (angiotensin II receptor blocker twice a day, calcium channel blocker twice a day, beta blocker once a day, thiazide diuretic once a day).

Cardiac status: 65 % FE

Carotid duplex: diffuse parietal disease with left carotid stenosis > 70 % with calcified ulcer

Angio CT scan: diffuse parietal atherosclerosis on left carotid artery with stenosis > to 70% and ulceration. Type I arch.

Carotid treatment

Angio CT

pre-angiogram