2014 Volume 8 Issue 2 Pages 95-100
Objective: A patient with renal failure and severe stenosis of the internal carotid artery on the right side of the neck underwent carotid artery stenting (CAS) with almost no use of contrast medium, as reported here.
Methods: OPTIMO, a 9-Fr balloon-tipped guiding catheter, was inserted in the femoral artery and placed in the common carotid artery in accordance with fusion images from a neck MRI scan and carotid MRA. A PercuSurge GuardWire was placed in the external carotid artery with ultrasound guidance. Balloons in the common carotid artery and external carotid artery were inflated and antegrade flow was blocked. After imaging was done with a small amount of diluted contrast medium, the contrast medium was promptly suctioned and collected. Intra-vascular ultrasoundgraphy (IVUS) was used to measure the length of stenotic lesions and the size (diameter) of the internal carotid artery and common carotid artery. Pre-dilatation was done, a stent was placed with ultrasound guidance, and then post-dilatation was done. Dilatation was confirmed with IVUS, whereupon the procedure concluded.
Results: The patient’s postoperative course was uneventful, and the patient was discharged after 5 days. Follow-up ultrasound of the carotid artery revealed that the stent was patent.
Conclusion: The technique described is a useful one since it allows CAS to be safely performed using carotid ultrasound, fusion images from a neck MRI scan and carotid MRA, and IVUS even in cases where use of contrast medium is not feasible.
