INSTITUTION: Carolinas Medical Center (Charlotte, NC)

PHYSICIAN: Joe Bernard, M.D., and Richard Bellon, M.D.

DESCRIPTION OF PROCEDURE: Primary stenting of MCA

DATE OF PROCEDURE: November 7, 2001

PRESENTING SYMPTOMS: Episodic transient left arm weakness. Patient was a 60 year-old female on Coumadin with multiple TIA’s in the right middle cerebral artery distribution. She had been angioplastied twice previously at another institution with recurrent symptomatic stenosis of her right middle cerebral artery.

THERAPEUTIC OBJECTIVES: Stent and angioplasty of right middle cerebral artery stenosis.

DESCRIPTION OF PROCEDURE: The patient was started on aspirin and Plavix one-week prior to the procedure. An arterial sheath and guide catheter were placed into the right internal carotid artery, and the patient was then given an Integrilin infusion. The size of the vessel was determined with an external reference object in a plane perpendicular to the working projection. A MULTI-LINK PIXEL™ 2mm x 8mm balloon-mounted coronary stent (Guidant Corporation) was navigated to the M1 segment of the middle cerebral artery over a 0.014” exchange length (300 cm) SYNCHRO™ Neuro Guidewire (Precision Vascular Systems, Inc.) in a single pass and inflated to 7 atmospheres. The patient was discharged 24 hours later and remains symptom free at six months.

OBSERVATIONS ON GUIDE WIRE PERFORMANCE: The SYNCHRO™ Neuro Guidewire exhibited excellent steerability and support. The stent and angioplasty balloon tracked very well. Usually there is so much resistance to forward push that the guide / sheath will recoil back into the aortic arch, or at least into the proximal common carotid artery. There was amazingly little resistance to forward push with this combination, and it has become a very useful tool to have in our arsenal.

LIST OF DEVICES USED:

• 0.014” SYNCHRO™ Neuro Guide Wire Model 1331, Precision Vascular Systems, Inc.
• 2mm x 8mm MULTI-LINK PIXEL™ Stent, Guidant Corporation