Ultrasound-guided carotid artery stenting with no use of iodinate contrast medium

Abstract

In carotid artery stenting (CAS), iodinated contrast medium is generally required, however, iodinated contrast medium is hard to use for the patient of renal failure and iodine allergy. In 9 carotid artery stenosis in 8 patients with chronic renal failure and iodine allergy. CAS was performed guided by carotid ultrasound and intravascular ultrasound (IVUS) without use of the iodinate contrast medium. Ultrasound was useful for crossing the guidewire, decision of the position of the stent, evaluation of the in-stent plaque protrusion, and measurement of peak systolic velocity (PSV) in the stenotic lesion and the deployed stent. Pre-and post-operative mean PSV measured by ultrasound were 235 ± 115 and 99 ± 42 cm/s, respectively. Ultrasound-guided CAS is therefore suitable for patients with renal failure and iodine allergy, except for cases involving high position, elongated carotid artery stenosis.