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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports
Peng-Cheng Fu, Jing-Yi Wang, Ying Su, Yu-Qi Liao, Shao-Ling Li, Ge-Lin Xu, Yan-Jiao Huang, Ming-Hua Hu, Li-Ming Cao
Peng-Cheng Fu, Ge-Lin Xu, Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
Jing-Yi Wang, Faculty of Chinese Medicine, Macau University of Science and Technology, Macau 999078, China
Ying Su, Graduate School, Guangzhou Medical University, Guangzhou 511495, Guangdong Province, China
Yu-Qi Liao, Shao-Ling Li, School of Medicine, Shenzhen University, Shenzhen 518000, Guangdong Province, China
Yan-Jiao Huang, Medical Department, Baise People’s Hospital, Baise 533000, Guangxi Zhuang Autonomous Region, China
Ming-Hua Hu, Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, Hunan Province, China
Li-Ming Cao, Clinical College of the Shenzhen Second People’s Hospital, Anhui Medical University, Shenzhen 518000, Guangdong Province, China
Author contributions: Hu MH and Cao LM designed the study and provided resources; Fu PC and Wang JY acquired and analyzed data, and wrote the manuscript; Fu PC and Xu GL performed the interventional procedures; Su Y, Liao YQ, Li SL, and Huang YJ analyzed the imaging and provided constructive discussion; and all authors have read and approved the final manuscript. Fu PC and Wang JY have contributed equally to this work and share the first authorship. Hu MH and Cao LM contributed equally to this work.
Supported by Shenzhen Second People’s Hospital Clinical Research Fund of the Shenzhen High-level Hospital Construction Project, No. 20223357021 and 20223357030; and Research Project of Teaching Reform in Shenzhen Second People’s Hospital, No. 202209.
Informed consent statement: The patient has provided informed consent for publication of the case.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Li-Ming Cao, MD, PhD, Adjunct Associate Professor, Clinical College of the Shenzhen Second People’s Hospital, Anhui Medical University, No. 3002 Sungang West Road, Shenzhen 518000, Guangdong Province, China.
caolm-2007@163.com
Received: June 8, 2023
Peer-review started: June 8, 2023
First decision: August 31, 2023
Revised: September 9, 2023
Accepted: September 25, 2023
Article in press: September 25, 2023
Published online: October 16, 2023
Processing time: 126 Days and 23.3 Hours
BACKGROUND
Digital subtraction angiography (DSA), the gold standard of cerebrovascular disease diagnosis, is limited in its diagnostic ability to evaluate arterial diameter. Intravascular ultrasonography (IVUS) has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery stenting (CAS).
CASE SUMMARY
Case 1: A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke. Physical examination showed decreased strength (5-/5) in both lower limbs. Carotid artery ultrasound, magnetic resonance angiography, and computed tomography angiography (CTA) showed a right proximal internal carotid artery (ICA) stenosis (70%-99%), acute cerebral infarction, and severe right ICA stenosis, respectively. We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation. Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence. CTA six months postoperatively showed no significant increase in in-stent stenosis. Case 2: A 36-year-old man was admitted with a right common carotid artery (CCA) dissection detected by ultrasound. Physical examination showed no positive neurological signs. Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow (dissection or carotid web). IVUS-assisted DSA confirmed right CCA dissection. CAS was performed and intraoperative IVUS suggested a large residual false lumen. Post-stent balloon dilatation was performed reducing the false lumen. DSA three months postoperatively indicated good stent expansion with mild stenosis.
CONCLUSION
IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively, dissection and stenosis morphology intraoperatively, and visualizing and confirming CAS postoperatively.
Core Tip: Intravascular ultrasonography (IVUS) improves carotid artery stenting (CAS) evaluations and outcomes vs those of the traditional gold-standard, digital subtraction angiography (DSA). We present two cases of cerebrovascular diseases. Case 1 involves a 65-year-old patient with stroke. IVUS-assisted CAS was performed after right proximal internal carotid artery stenosis was diagnosed via DSA. Preoperative IVUS imaging showed a low-risk plaque and accurately measured the stenosis. Postoperative IVUS confirmed good stent expansion and adherence, and the patient had no discomfort at 4-mo follow-up. Case 2 involves a 36-year-old patient with common carotid artery dissection, confirmed via IVUS-assisted DSA, and CAS was performed. Intraoperative and postoperative IVUS imaging showed the size of the true and false lumen, assisted in treatment decision-making, and confirmed CAS outcomes. This paper highlights the crucial role of IVUS in decision-making during CAS. IVUS can facilitate the accurate assessment of carotid artery wall lesions and plaque nature preoperatively, measure stenosis and true and false lumen size intraoperatively, and confirm CAS effects postoperatively.
