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Figure 3 Carotid Stenting in a Symptomatic Patient

An 82-year-old man with a recent transient ischemic attack affecting the right hemisphere of his body, and accelerating angina, was noted to have a high-grade stenosis in the left internal carotid artery by duplex ultrasonography. (A) Angiography reveals a 90% stenosis of the left internal carotid artery. (B) Owing to proximal vessel tortousity, after the sheath is placed in the common carotid artery, tortousity is displaced distally to the internal carotid artery. (C) After placement of a distal embolic protection device Accunet (Guidant, Temecula, California) and treating the lesion with a self expanding 6 to 8 x 40 mm Acculink (Guidant) nitinol stent, 60% residual stenosis remains. (D) After balloon dilation with a 5.0 x 20 mm ViaTrac balloon (Guidant), <30% residual stenosis remains. CC = common carotid artery; EC = external carotid artery; IC = internal carotid artery.