Usefulness of the fusion imaging of 3D-CT and MRA for carotid artery stenting with minimum use of contrast medium in patient with renal dysfunction.
Patients with severe internal carotid artery (ICA) stenosis with multiple medical problems generally undergo carotid artery stenting (CAS). However, it is difficult to perform CAS in some patients because iodinated contrast medium is hard to use. We report a patient with asymptomatic ICA stenosis and chronic renal failure, in whom successful treatment was achieved using CAS with minimal use of iodinated contrast medium. A 68-year-old man with severely chronic renal failure was consulted for treatment of left ICA stenosis. Magnetic resonance angiography (MRA) and carotid echography revealed left ICA severe stenosis, and systemic non-contrast MRA showed left femoral artery constriction, but right femoral artery to be intact. CAS was therefore performed through the right femoral artery, using non-contrast three-dimensional computed tomography (3D-CT) with MRA fusion imaging, intravascular ultrasonography, and a small amount of iodinated low-osmolar contrast medium. Postoperative course was uneventful with no aggravation of renal dysfunction, and he was discharged 7 days postoperatively. These techniques are very useful for patients with chronic renal failure, and this present case represents the first report of CAS treated by using non-contrast 3D-CT with MRA fusion image technique.
Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan iakihiro3@gmail.com.
Akihiro
A
Inoue
Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
Masahiko
M
Tagawa
Department of Regeneration of Community Medicine, Ehime University School of Medicine, Toon, Japan.
Yoshiaki
Y
Kumon
Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
Hideaki
H
Watanabe
Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
Shiro
S
Ohue
Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
Yoshihiro
Y
Ohtsuka
Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
Yawara
Y
Nakamura
Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
Takanori
T
Ohnishi
D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007676:Kidney Failure, Chronic / Q000150:complications*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography
D003287:Contrast Media
Carotid artery stenting; chronic renal failure; fusion image; non-contrast three-dimensional computed tomography; systemic magnetic resonance angiography