Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports  

作　　者：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 

机构地区：[1]Department of Neurology,The First Affiliated Hospital of Shenzhen University,Shenzhen 518000,Guangdong Province,China [2]Faculty of Chinese Medicine,Macao University of Science and Technology,Macao 999078,China [3]Graduate School,Guangzhou Medical University,Guangzhou 511495,Guangdong Province,China [4]School of Medicine,Shenzhen University,Shenzhen 518000,Guangdong Province,China [5]Medical Department,Baise People’s Hospital,Baise 533000,Guangxi Zhuang Autonomous Region,China [6]Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations,Changsha Medical University,Changsha 410219,Hunan Province,China [7]Clinical College of the Shenzhen Second People’s Hospital,Anhui Medical University,Shenzhen 518000,Guangdong Province,China

出　　处：《World Journal of Clinical Cases》2023年第29期7127-7135,共9页世界临床病例杂志

基　　金：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.

摘　　要：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 sten-ting(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.

关 键 词：Intravascular ultrasonography Carotid artery stenting Carotid stenosis Arteriosclerotic stenosis Carotid artery dissection Case report 

分 类 号：R651.12[医药卫生—外科学]