Trellopoulos GeorgiosVascular surgeon

Gen. Hosp. “G. Papanikolaou”, Thessaloniki

CAS in simple steps

The standard procedure

Step 1• Puncture common femoral artery• Sheath placement 7Fr.• Advance guide wire Terumo stiff 180cm to

aortic arch.Terumo guide wire

Step 2• Advance Guiding catheter

and catheterization of CCA. • Advance of guiding

catheter 3cm proximal of the carotid bifurcation:

1. The guide wire is placed to the external carotid artery after road map

2. The guide wire is placed to the common carotid artery

Judkins Right JR4.0 :7Fr: 0.081” 8Fr: 0.090”

Multipurpose MB1 : 7Fr: 0.081” 8Fr: 0.090”

Step 3

• Appropriate orientation of the C-ARM to “open” the carotic bifurcation

• Diagnostic angiography or ROADMAPFoto1.wmv

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Step 4• Gently passage of the

guide wire 0,014΄΄ or the protection device (filter) and placement peripherally in a straight segment

Advance Guidewire and Delivery System together to intermediate point (eg start of Aortic Arch).

Advance Guidewire alone across lesion (BAREWIRE ADVANTAGE)

Follow with Delivery Catheter and deploy Filter

A

B

Filter placement recommendations•Place the filter in a straight and disease-free segment of the artery

•Adequate distance between the proximal tip of the filter and the most distal tip of any interventional device to be introduced. (A)

Minimum 1.5 cm is recommended

•Adequate distance between the proximal end of the 0.014” radiopaque distal tip of the BareWire and the distal tip of the filter. (B)

Step 5• Angiography and

advance of the delivery system

• Placement of straight / tapered and closed / opened stent Straight Tapered

Distal edge of stent

Proximal marker

Step 6• Postoperative ballooning

using a mono-rail balloon 5mm X 2cm with quick manner, to 4 – 5 Atm.

Step 7

• Control angiography for checking result

Step 8 • Retrieval of the filter and angiography control of intracranial vessels face and profile

Questions:

1. Which is the minimum distance between the proximal tip of the filter and the most distal tip of any interventional device?

• 1cm• 1,5cm• 2cm• 2,5

2. Which is the minimum ID (internal diameter) of guiding catheter to allow passage of the delivery system?

• 0,071΄΄• 0,075΄΄• 0,081΄΄• 0,085΄΄

Answers:

1. Which is the minimum distance between the proximal tip of the filter and the most distal tip of any interventional device?

• 1cm• 1,5cm• 2cm• 2,5

2. Which is the minimum ID (internal diameter) of guiding catheter to allow passage of the delivery system?

• 0,071΄΄• 0,075΄΄• 0,081΄΄• 0,085΄΄

1,5cm

0,081΄΄

Thank you for your attention!