title: Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction.
abstract: BACKGROUND
  We aimed to investigate the safety and feasibility of duplex-assisted carotid artery stenting (CAS) without administration of contrast medium for the prevention of adverse reactions.
  
  
  METHODS
  Fifteen patients (9 % of all CASs) with severe carotid stenosis (≥70 %) associated with chronic kidney disease (CKD) (stage ≥3) or allergy to contrast medium underwent duplex-assisted CAS without administration of contrast medium over 4 years. The procedural success rate and perioperative complication rates were compared between the duplex-assisted CAS (n = 15) and conventional CAS (n = 153) groups.
  
  
  RESULTS
  The technical success rate was 100 % in both groups. Combined stroke or death rates during the post-procedural period did not differ significantly between the duplex-assisted CAS group (0/15, 0 %) and conventional CAS group (4/153, 2.6 %). None of the 14 patients with CKD in the duplex-assisted CAS group experienced further deterioration of renal function. The mean surface radiation dose of participants in the duplex-assisted CAS group (n = 13, 312 ± 131 mGy) was significantly lower than that of the conventional CAS group (n = 31, 1036 ± 571 mGy) (p < 0.001). The mean duration of CAS procedure was not significantly different between the duplex-assisted CAS group (156 ± 39.7 min) and the conventional CAS group (156 ± 37.4 min).
  
  
  CONCLUSIONS
  Duplex-assisted CAS without administration of contrast medium could be an alternative option in selected patients deemed to be at high risk for renal failure from nephrotoxic contrast medium or who have an allergy to contrast medium.
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. mizowakit@yahoo.co.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizowaki
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujita
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Taichiro
authors.initials: T
authors.lastname: Imahori
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Uyama
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kohta
authors.affiliation: Department of Neurology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hamaguchi
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasayama
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Kohkichi
authors.initials: K
authors.lastname: Hosoda
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kohmura
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D003287:Contrast Media; D004342:Drug Hypersensitivity / Q000517:prevention & control; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Carotid artery stenting; Carotid stenosis; Chronic kidney disease; Contrast medium-induced nephropathy; Duplex ultrasound