angioplasty and stenting

Procedure angioplasty and stenting

Materials
1. 2% lignocaine loaded in 10 ml syringe
2. 7F arterial sheats(orange)
3. puncture needle (16G/18G)
4. 5 F/6 F diagnostic cath, 

5. Standart length  wire 0,035"150 cm ((terumo)

6. Exchange guidewire 0,035" 300 cm
7. Guiding cath7F acculink

8. Baloon cath (viatrac 14 plus)

9. Stent (Xact)
10. 3 way stopcocks
11. small bowl
12. large bowls with heparinized saline 1.000 units/ 500 ml saline
13. pressure saline bags with heparinized saline 10.000 units/1 liter each-->two bags
13. contrast non ionic (omnipaque)
14. 10 ml syringe 3

technique
1. insert anestesia, insert needle
2. insert 7 F arterial sheath
3. 2.000 heparin iv
4. if tortuous vesels: insert diagnostic cath first
    if good vessels : directly insert guiding cath
5. After reaching CCA-->park exchange wire (terumo 300 cm, 0,035"/0,038") in  ECA
6. place guiding cath into infra petrousal ICA--> connect with saline bags by 3 waystopcocks making coaxial system
8. negotiate microwire acros stenosis (Hi Torque 0,014" 190 cm)

9. Placement of embolic protecting device if required

10. advancement of stent over the microwire wth aproriate placement of stent across the stenosis covering the full length of stenosis.

11. deployment of the stent and removal of stent accessories. Check the stent position under roadmap or cine or in unsubstracted images as per bony landmark.

12. preatropinitation before balloon dilatation to prevent bradicardia.

13. insertion of balloon cath for angioplasty across the stenosis followed by dilatation usually up to 6-8 atm for 10-30 s.

14. postangioplasty angiogram to look for flow across the stent and any redidual stenosis. Make sure there is no residual stenosis and there is good stent apposition across the wall. There should not be any cut off the vessels in neck and circle of willis angiogram.