Animesh Rathore, M.D., presents a case study of a 69 year old patient with high grade carotid artery stenosis and multiple comorbidities. Due to the high risk of standard surgery, Dr. Rathore opted to perform a TCAR and that procedure is highlighted in this video.
Hello. My name is an image data and one of the vascular surgeons with Sentara vascular specialist and I work primarily at Sentara Norfolk general Hospital. Uh We are talking about one of my patients who showed up to our office with a high grade corroded artery stenosis. She is a 69 year old female with multiple commodities including congestive heart failure, coronary artery disease, hypertension and diabetes because of her comorbidities and high grade stenosis. While she needed a corroded artery revascularization, she was considered high risk for the standard operation which would be corrected endarterectomy. We therefore offered a new technique to her called the car or transported artery revascularization. Here we will talk about the nuances of this new surgery. So this is a ct angiogram in the corona view showing the hybrid stenosis of her left internal corroded artery. This is a still shot, confirming the same findings. This patient was also violated with the ultrasound showing elevated peak systolic and diastolic velocities, Conforming 80- 99% stenosis of the internal credit artery. So in this procedure we survey her neck, identified the common carotid artery on the left side. Using that mark making season exposed the common carotid artery with help of electric artery and dissection with the pastor loop around the artery. We're also establishing access in the left common femoral vein to establish our flow reversal circuit, which we'll see shortly. We're just pushing the sheep. This cartoon depicts the technology where we are obtaining access in the common corroded artery. As described first researcher to establish access followed by needle entry. There would be a ship going in for the establishment of flow reversal. Now this eight friends sheet gets connected by a flow reversal channel into the common femoral vein. With the pressure gradient preferentially flowing towards the femoral vein from the artery there is a critical that will capture any of the potential traumas that could have possibly gone towards the brain. There is a low and high flow reversal switch on the system and with the establishment we now access internal corroded artery pre dilate and proceed. Here are video showing these steps where we are establishing the flow reversal and conforming it on the floor reversal mechanism. And as we do this establishes our hybrid operating room with the setting of ceiling mounted X rays. Here we have already established the flow reversal for the patient. Angiogram confirms the stenosis. And following this we will cross this area and deploy our stent which ended up being a self expanding. Very mental stand as being deployed as you can see the stand getting deployed nicely there. He had already done the balloon angioplasty. We can form our finding on the angiogram with the large monitors we have in our hybrid operating room confirming the nice flow. Following this, we wait for two minutes to let any debris embolism towards the way by the filter. Here we are removing our access while tying down the pre close soldiers that were placed and the skin and seasoned being closed here. This ends up being a small in season performed under monitored anesthesia care and local anesthesia, avoiding general anesthesia. This is a picture of a filter. These potential plots could have gone to her brain and given her a stroke. This patient was followed with the ultrasound that showed resolution of stenosis. She did extremely well and left the hospital on post op Day number one, with excellent results. She's very thankful to her surgery.