Utility of intravascular ultrasound examination during carotid stenting.
BACKGROUND
Intravascular ultrasound (IVUS) examination may provide useful information during endovascular procedures. However, its actual clinical utility for carotid stenting remains unclear. We evaluated the usefulness of IVUS as a complementary tool during endovascular procedures in the carotid arteries and its impact on the modification of the therapeutic strategy.


METHODS
Between April 2006 and April 2007, 18 symptomatic patients (nine with transient ischemic attack, nine with stroke) underwent angioplasty and stenting of >70% stenosis of the internal carotid artery (ICA). Target lesions were identified with preoperative duplex scanning and further confirmed at angiography. Intraoperative IVUS examination was performed in all patients. Multilevel measurement of the artery as well as virtual histology images, before and after stenting, were obtained.


RESULTS
The technique was 100% successful. There were no complications at the femoral puncture site and no neurological or other events. Compared with angiography, IVUS findings showed an average arterial diameter that was greater than 1.64+/-0.22mm. Based on virtual histology information, endovascular treatment was excluded in two patients and carotid endarterectomy was performed. Type or size of the stent was modified after IVUS examination in eight cases.


CONCLUSIONS
IVUS examination provides complementary information to that obtained using conventional diagnostic procedures. It may be useful for characterizing the composition and measurement of the target lesion, choosing the type and size of the stent, and evaluating the results after the procedure.
Joan
M Mellado
MM
Servicio de Angiologia, Cirugia Vascular y Endovascular, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain. txellmellado@hotmail.com
Moya
B Gómez
BG
Agustí
F Pañella
FP
Vidal
R García
RG
Arjona
Y Abril
YA
Alija
M P Fariñas
MP
Paredero
V Martín
VM
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D002533:Cerebral Angiography; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional