20190628 Viabahn (Cover stent) deployment

• Hx of patient: extended right oral cancer, progressive enlarged lump at right neck with pus

• Equipment
• Flush *1 
• 150 cm .35  and .18 wire
• 7 Fr. shuttle sheath with Y shape tube, JB2 catheter
• 8 mm x 5 cm Viabahn stent
• Informed consent and explained the risks.
• Stroke, Intra-stent thrombus
• Re breeding, too large of the opening that our stent could not cover
• Tortuous vessel which we could not approach.
• Cover ECA, risk of ischemia
• If untreated, rupture of the pseudoaneurysm and large amount active bleeding.
• Steps:
• Set Flush line x 1, connect to shuttle sheath
• Puncture right femoral artery, then inserted 7 Fr. shuttle sheath with stylet into abdominal aorta
• Remove stylet, open flush line
• Prepare the bi-plane fluoroscopy. Slightly LAO of the AP arm to see the opening of pseudoaneurysm clearly(?).
• Put .35 wire into JB2 catheter, then inserted JB2 with .35 wire into Shuttle sheath
• Put the JB2 into right CCA, then perform road map via JB2
• Confirm the pseudoaneurysm diagnosis and location, then inesrted  .35 wire again, put the wire over the opening of pseudoaneurysm. Then advanced the JB2 over the opening, and push the shuttle into CCA. Then remove JB2 and .35 wire.
• Performed right CCA angiography with 5 ml/total 8 ml. Confirm the location of the opening of the pseudoaneurysm which is about at lower border of 3th vertebral body.
• We measure the diameter of proximal ICA(5.96 mm), distal CCA(7.17 mm) and the distance from ICA to CCA(44mm). Then, we decided to use 8 mm x 5 cm Viabahn. (althought the carotid bulb is 8.4 mm, the 8 mm stent is large enough to cover the proximal CCA)
• Flush the Viabahn and inserted .18 wire into the Viabahn(from tip due to I could not inserted via tail)
• Put the Viabahn with .18 wire into shuttle, push the wire over the tip.
• Put the .18 wire over the opening, then  push the Viabahn to the desired position(From middle of 3rd vertebral to CCA)
• Confirm fasten the Y shape tube, and confirm the location of the stent, and Rapid remove the thread and open the stent.
• Follow up road map revealed only delay flow into the pseudoaneurysm.
• Follow up DSA of right CCA and then remove the Shuttle sheath into descending aorta.
• Check the patient's conditions if any stroke symptoms occurred.
• Sent to patient to ward or ICU.

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