title: Adjunctive ultrasonography during carotid artery stenting to minimize iodine contrast use.
abstract: Carotid artery stenting (CAS) in patients with chronic kidney disease carries a significant risk of contrast-induced nephropathy. We report a case of CAS with adjunctive sonography to reduce the amount of contrast medium during angiography. A 71-year-old man presented with a symptomatic right carotid stenosis. He was selected for CAS due to significant medical comorbidity, which included severe renal impairment. A preoperative noncontrast CT was performed to assess anatomical suitability and to plan arch vessel cannulation. We undertook CAS with the use of intraoperative ultrasound. Sonography was used to monitor the manipulation of wires, catheters, and stents. Four milliliters of contrast was required to complete the procedure successfully with no deterioration in postoperative renal function. Adjunctive ultrasound is feasible to reduce contrast use in patients with severe renal impairment undergoing CAS.
authors.affiliation: Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors.forename: Isuru
authors.initials: I
authors.lastname: Nammuni
authors.forename: Paul
authors.initials: P
authors.lastname: Batt
authors.forename: Jonathan
authors.initials: J
authors.lastname: Erlich
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Varcoe
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D003287:Contrast Media / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol