Intravascular ultrasound for intracranial angioplasty and stent placement: technical case report.
OBJECTIVE
Intravascular ultrasound (IVUS) imaging has been used extensively in coronary artery interventions and has provided invaluable information for the understanding and treatment of coronary arterial disease. We present here the first description, to our knowledge, of IVUS-guided intracranial arterial interventions in the clinical setting.


METHODS
Two patients underwent intracranial angioplasty and stent placement with the assistance of IVUS for the evaluation of their lesions. One patient underwent stenting to treat an occlusive dissection of the left internal carotid artery that occurred during arteriovenous malformation embolization. Another patient underwent angioplasty and stenting for high-grade restenosis of a basilar artery atherosclerotic lesion.


RESULTS
Both patients underwent successful revascularization procedures. The patient with the dissection had a small intraventricular and parenchymal hemorrhage documented by computed tomography 4 hours after treatment, but did not develop hydrocephalus or further hemorrhage. Both patients did well clinically and had no permanent neurological deficits. IVUS provided important information in terms of lesion evaluation, stent selection, and stent placement in each case.


CONCLUSIONS
IVUS of the intracranial circulation may assist the performance of intracranial angioplasty and stenting. It provides useful information that can affect clinical decisions. It may prove to be a valuable tool in clinical use and enhance our understanding of vascular disease of the intracranial circulation, as it has in the coronary circulation.
Wehman
J Christopher
JC
Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
Holmes
David R
DR
Hanel
Ricardo A
RA
Levy
Elad I
EI
Hopkins
L Nelson
LN
D000368:Aged; D017130:Angioplasty / Q000379:methods*; D001807:Blood Vessel Prosthesis; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*