Published online Sep 6, 2023. doi: 10.12998/wjcc.v11.i25.5926
Peer-review started: April 28, 2023
First decision: July 18, 2023
Revised: August 3, 2023
Accepted: August 9, 2023
Article in press: August 9, 2023
Published online: September 6, 2023
Processing time: 125 Days and 15.1 Hours
Ischemic stroke is an entity with high incidence, morbidity, and mortality rates. Carotid artery stenosis is an important and independent risk factor for ischemic stroke. The three current approaches for treating carotid artery stenosis are drug treatment, carotid endarterectomy (CEA), carotid angioplasty and stenting (CAS). The approach is chosen based on the degree of stenosis. CEA or CAS could have been chosen for the current patient, who had severe carotid stenosis and an iodinated contrast allergy. After thoroughly communicating with the patient, the patient chose CAS for treatment. Therefore, we performed ultrasound-guided CAS to avoid the use of iodinated contrast.
The main symptoms of the patient were numbness and weakness of the left limb. Computed tomography angiography of the head and neck at another hospital indicated multiple sites of stenosis in the arteries of the head and neck. The patient requested CAS for treatment but was allergic to iodinated contrast media. Thus, routine digital subtraction angiography (DSA) with iodinated contrast could not be used for the procedure. The diagnosis of this patient was as follows: (1) Right parietal lobe cerebral infarction; (2) multiple sites of stenosis in the arteries of the head and neck (severe stenosis of the right internal carotid artery, severe stenosis of the right subclavian artery); (3) right subclavian steal syndrome; and (4) hypertension (stage 3, high risk). The interventions included routine treatment for cerebral infarction, oral administration of clopidogrel (75 mg qd) and aspirin (100 mg qd), ultrasound-guided CAS, and postoperative follow-up. Postoperative color Doppler ultrasound and cerebrovascular magnetic resonance angiography of the carotid artery showed good vascular recovery, and the postoperative follow-up indicated a good prognosis.
This case study suggests that ultrasound-guided endovascular treatment is a potential option for patients with contraindications to the iodinated contrast agents used in DSA-guided surgery, although excellent surgical operating skills are needed.
Core Tip: We report a case of patient who had severe stenosis of the right internal carotid artery and severe stenosis of the right subclavian artery. The patient requested carotid angioplasty and stenting (CAS) for treatment but was allergic to iodinated contrast media. Therefore, we performed ultrasound-guided CAS to avoid the use of iodinated contrast. Ultrasound and magnetic resonance examination showed good vascular recovery, and the postoperative follow-up indicated a good prognosis. The case suggests that for patients who are allergic to iodinated contrast media, ultrasound-guided CAS is a feasible alternative.