Ultrasound-guided carotid artery stenting through distal balloon protection

Abstract

Background and purpose: Carotid artery stenting (CAS) usually requires iodinated contrast medium; however, using iodinated contrast medium is difficult for patients with chronic kidney disease and iodine allergy. We report the case of a patient with chronic kidney disease and severe stenosis of the internal carotid artery (ICA) on the right side of the neck who underwent CAS through a balloon distal protection device with little use of contrast medium. Case: A 79-year-old male was admitted to our hospital for left hemiplegia. Diffusion MRI revealed an acute symptomatic brain infarcts in the right hemicerebrum; a carotid duplex ultrasound revealed right ICA stenosis (peak systolic velocity, 287cm/s). Blood test showed chronic kidney disease (eGFR, 33.8ml/min/1.73m 2). Ultrasound-guided CAS was performed to use a minimized contrast medium. Ultrasound-guided CAS plays a vital role in the assessment of distal balloon protection, including inflation or deflation of a balloon. The total volume of iodinated contrast medium was 7ml. The day after CAS, the patient did not develop contrast mediuminduced nephropathy. Conclusions: Ultrasound-guided CAS is safe and feasible for patients with preexisting chronic kidney disease, and intraprocedural status change can be confirmed in real time.