Emergency Stenting of Tandem Stenoses of the Internal Carotid Artery Using Proximal Protection Against Distal Embolism “MoMa”

Man, 61 years old. Admitted with complaints of severe weakness in the right limbs, which developed about 4 hours ago. Multispiral computed tomography cerebral angiography: signs ischemic stroke basin left middle artery. Angiography brachiocephalic arteries (BCA) was performed: angiographic damage to BCA: internal carotid artery (ICA) C2–C3 segments up subocclusion, 75% mouth and third. The circle Willis is closed. A multidisciplinary council made a decision on emergency stenting tandem ICA stenoses using proximal protection against distal embolism “MoMa”. course operation: after angiography, sheath introducer replaced by guidewire 9F introducer. system “MoMa” installed along diagnostic conductor 260 cm at external (ECA) third common (OCA). Baloons ECA OCA were inflated. Promus element 4.0x12 mm (DES) brought into affected area segments, positioned opened pressure 14 atm. balloon catheter has been removed. Aspiration from ICA. On check residual stenosis zone 0%. test angiography intracranial without embolism. Protege (7x10x40) stent placed, deployed orifice delivery control postoperative period uneventful. 10th day stenting, neurological deficit regressed completely, patient discharged for outpatient observation satisfactory condition. CONCLUSIONS When performing brain revascularization most acute stroke, it necessary take account recommendations multicenter studies that report such conditions successful outcome operation as: diameter focus brain, not exceeding 2.5 absence (more than Rankin scale score 2). Within framework this clinical example, these taken account, which, among other things, contributed optimal urgent revascularization. Emergency device effective presence closed structure Willis. technical complexity associated installation guide its 9 Fr (catheters 7 are usually used), requires additional manual skills.