1. Slow-Flow During Carotid Intervention
Ochsner Clinic Foundation
New Orleans

2. History 62 year old attorney with asymptomatic bruit.
Critical stenosis by CFD.
High bifurcation.
Offered surgery, refused.
Referred for Carotid Stent.
Obtained coverage from his insurance company.

3. Baseline angiogram

4. Baseline angiogram

5. Baseline angiogram

7. Baseline angiogram

8. Baseline Angiogram

9. Sheath in place RCCA

10. Lesion crossed with buddy wire

11. Filter deployed distal ICA

12. Slow flow post stenting

13. Normal Flow after aspiration and filter removal

14. Before and After Stenting

15. Post intervention

16. Post intervention

17. 4 hours after procedure Nurse notifies staff MD
Complications/Patient complains of
Decreased visual acuity
Right sided headache
What happened?
What should we do?

18. Emboli to Retinal Artery
Baseline
18 Seconds
70 Seconds

19. Fluoroscine Angiogram of the Retina

20. Follow up
With ophthalmologist, neurologist and Interventional cardiologist at 1 month
Ophthalmology note
Vision improving
Multiple bright emboli but less than initially
Continue on Aspirin and plavix

21. Conclusion Atheroemboli occur in virtually all interventions.
They are a marker for adverse outcomes with
angioplasty in all vascular beds.
Emboli in the coronary and carotid beds are
especially important clinically.
We have proven that embolic protection
makes percutaneous intervention safer than
intervention without protection (SAFER) in SVG’s.
To assume that embolic protection will prevent all emboli is naive.
When slow flow occurs, immediate and vigorous aspiration is required to remove the debris that is in solution in the stagnant column.!