title: Intravascular ultrasound-guided thrombus retrieval with a multipurpose-angled catheter during carotid artery stenting.
abstract: Intravascular ultrasound (IVUS) has provided invaluable real-time information during carotid artery stenting (CAS). We present a case of IVUS-guided thrombus extraction during CAS. A 46-year-old man underwent an urgent right CAS under proximal flow reversal for embolic protection for a hemodynamically significant symptomatic near-occlusion of the internal carotid artery. IVUS was used to evaluate immediate poststenting results and identify potential thromboembolic material extruding through the tines of the stent. An intraluminal thrombus was identified with IVUS after the stent was deployed. This led to the use of a second stent in an attempt to trap the thrombus. Ultimately, the thrombus was removed with the use of a multipurpose-angled catheter under IVUS guidance. The artery reconstituted almost completely after stent placement, and the patient's condition improved significantly. IVUS identification of intraluminal thrombus allowed additional maneuvers to be performed to prevent distal embolization and postprocedure stroke.
authors.affiliation: Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
authors.forename: Mandy J
authors.initials: MJ
authors.lastname: Binning
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
mesh_terms: D015901:Angiography, Digital Subtraction; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
chemical_list: D010975:Platelet Aggregation Inhibitors