title: Adjunctive ultrasonography to minimize iodinated contrast administration during carotid artery stenting: a randomized trial.
abstract: OBJECTIVE
  To report a single-center, prospective randomized controlled trial that compared contrast use during ultrasound-assisted carotid artery stenting (CAS) to CAS procedures without ultrasound.
  
  
  METHODS
  Between August 2010 and November 2011, 22 patients (18 men; mean age 72.8 years, range 62-84) with 25 severe symptomatic (n=3) or asymptomatic (n=22) carotid stenoses undergoing an endovascular intervention were randomly allocated (~1.1) to ultrasonography-assisted (n=13) or stand-alone (n=12) CAS. The primary endpoints were contrast use and number of selective cerebral injections. Secondary endpoints were procedure time, fluoroscopy time, any stroke, renal function assessment, major adverse cardiac events (MACE), and death.
  
  
  RESULTS
  In the study period, 23 of 25 scheduled CAS procedures (12 ultrasound-assisted, 11 control) were completed in 20 patients; 2 procedures were aborted owing to friable plaque and difficult guidewire access, respectively. There were no deaths, stroke, MACE, or precipitation of dialysis-dependent renal failure in either group. Iodinated contrast usage was reduced by 61% (45.4±24.4 vs. 17.8±11.9 mL, p=0.002) and number of selective cerebral contrast injections by 49% (8.3 vs. 4.2, p=0.002). Neither time taken to complete the procedure (32.5 vs. 35.4 minutes, p=0.38) nor fluoroscopy time (14.5 vs. 13.9 minutes, p=0.54) differed significantly between the groups. Creatinine levels remained stable after CAS and did not differ between groups.
  
  
  CONCLUSIONS
  Ultrasonography-assisted CAS is feasible and safe. Its use can significantly lower the usage of iodinated contrast and the number of selective cerebral circulation injections while not prolonging the length of the procedure or the fluoroscopy time.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Sydney, Australia. r.varcoe@unsw.edu.au
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Varcoe
authors.forename: Isuru
authors.initials: I
authors.lastname: Nammuni
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Lennox
authors.forename: Jia-Lin
authors.initials: JL
authors.lastname: Yang
authors.forename: Philip
authors.initials: P
authors.lastname: Crowe
authors.forename: William R
authors.initials: WR
authors.lastname: Walsh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003287:Contrast Media; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011446:Prospective Studies; D011474:Prosthesis Design; D015641:Radiography, Interventional; D051437:Renal Insufficiency / Q000209:etiology; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media