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Transcript of HMAA 2013
Adrien Racz, 6th year med. student
Nandor Pinter MD
Semmelweis University, Heart Center, Budapest, HU
- digital substraction angiography (DSA)
- percutaneous transluminal
angioplasty (PTA): balloon, stent
- ICA clamped
TIA, stroke, multifocal ischemic lesions, mortality
Diagnosis: noninvasive imaging
Therapy: CEA or CAS
CAS vs . CEA
> extent: 2-6mm
New ischemic lesions
Distribution of patients by new ischemic lesions
No. of isch. lesions
Transcranial Doppler (TCD): The premier multidimensional monitoring modality for carotid interventions
Adrien Rácz, Gábor Rosta, Zsolt Garami
Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center,
The Methodist Hospital – Houston, TX
Shunt or not to shunt?
Clamp on: Mean flow velocity (MFV) drops
Real-time hemodynamic information
Red: towards you, blue: away from you
Real-time decision making during carotid endarterectomy (CEA)
-Beside emboli detection
-Guiding our CEAs:
»Shunt placement needed?
»Improvement of procedure time, bleeding
-Monitoring wrong vessel
-Terminal ICA occlusion-inoperable
-1 postoperative stroke, MRI: watershed lesion
-3 MCA MFV didn’t improve
Angiography in these cases
»1 distal ICA occlusion
-102 patients, 78 male, 24 female,
average age: 68 y
-Right ICA: 54, Left ICA: 48
-Established need for shunt: 50% MFV drop
Thank you for your attention!