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Duplex-assisted internal carotid artery balloon angioplasty and stent placement
Enrico Ascher1, Anil P Hingorani, Natalie Marks
1Maimonides Medical Center, Division of Vascular Surgery, Brooklyn, New York 11219, USA. eascher@maimonidesmed.org
Insights
Duplex-assisted carotid artery balloon angioplasty and stenting (CBAS) is a feasible technique. This method may reduce contrast media usage, benefiting patients at high risk for renal failure.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Imaging
Background:
- Carotid artery balloon angioplasty and stenting (CBAS) is an alternative to carotid endarterectomy (CEA).
- High contrast media volume in traditional CBAS can impair renal function, especially in diabetic or renally compromised patients.
- Reducing contrast use is crucial for patient safety in CBAS procedures.
Purpose of the Study:
- To evaluate the feasibility of using duplex ultrasound guidance to minimize or eliminate contrast media during CBAS.
- To assess the safety and efficacy of duplex-assisted CBAS in selected high-risk patients.
Main Methods:
- Fluoroscopy guided initial guidewire manipulation and cerebral protection device placement.
- Selective internal and external carotid artery catheterization performed under ultrasound guidance.
- Balloon and stent deployment confirmed using ultrasound guidance alone, with duplex confirming stent apposition and patency.
Main Results:
- Successful balloon and stent deployment in all cases using ultrasound guidance.
- Duplex confirmed appropriate stent placement and arterial patency in all patients.
- One intraoperative ipsilateral stroke (2.9%) with near-complete recovery; no 30-day mortality.
Conclusions:
- Duplex-assisted CBAS is a feasible technique that can reduce contrast media requirements.
- This approach offers advantages including guidance for femoral puncture, precise device positioning, and confirmation of technique adequacy.
- Ultrasound-guided CBAS is a promising option for patients with high risk for contrast-induced nephropathy.
Abstract:
Carotid artery balloon angioplasty and stenting (CBAS) is gaining popularity as an adequate alternative to carotid endarterectomy (CEA) in selected patients. Unfortunately, the substantial amount of contrast media used for CBAS, traditionally performed under fluoroscopic guidance, may impair renal function in patients with diabetes or ones with elevated serum creatinine. We attempted to apply duplex assistance to limit or eliminate the use of contrast during CBAS. Fluoroscopy was utilized to assist manipulation of the guidewire into the aorta and the common carotid artery, and positioning of the distal cerebral protection device. Selective catheterization of the internal and external carotid arteries was performed under ultrasound guidance. Balloons and stent were successfully deployed with ultrasound guidance alone in all cases. Appropriate stent apposition and arterial patency were confirmed by duplex in all cases. One ipsilateral stroke (2.9%) occurred intraoperatively with almost complete clinical recovery in 4 months. On-table biplanar cerebral arteriogram performed in this patient was normal. No early (30-day) mortalities were in the series. Duplex-assisted CBAS is feasible and may reduce the need for contrast media in selected patients with high risk for renal failure. Additional advantages include guidance of the femoral puncture, precise position of the balloon and stent and B-mode and hemodynamic confirmation of the adequacy of the technique.