title: Cutting balloon angioplasty for carotid artery in-stent stenosis supported by three-dimensional rotational angiography with automated vessel analysis software.
abstract: In-stent stenosis is a possible long-term complication of carotid artery stenting. A simple and safe technique of cutting balloon angioplasty is described for carotid in-stent stenosis. The stented vessel is imaged by three-dimensional (3D) rotational angiography, the acquired projection images are transferred to a workstation, and the stenotic lesion and implanted stent are reconstructed. The diameter of the implanted stent in the stenotic region is measured by automated analysis software. Cutting balloon angioplasty carries the risk of vessel injury by the cutting balloon microblades, but the implanted stent acts as a barrier to protect the vessel. Therefore, cutting balloon inflation up to the stent diameter is safe and results in maximal vessel dilation. The key to success is precise measurement of the stent diameter and choice of a cutting balloon catheter of the appropriate size. 3D rotational angiography provides high-quality images of the vasculature of a stented vessel and a reference for intervention based on absolute measurements. Cutting balloon angioplasty supported by 3D rotational angiography with automated vessel analysis software should be considered as a treatment strategy for high-grade carotid artery in-stent stenosis.
authors.affiliation: Department of Neurosurgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan. yakiyama@med.shimane-u.ac.jp
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Akiyama
authors.forename: Kouzo
authors.initials: K
authors.lastname: Moritake
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kowari
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Sato
authors.forename: Toshio
authors.initials: T
authors.lastname: Shimada
mesh_terms: D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D015607:Stents; D025321:Surgery, Computer-Assisted