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

作者：Pengcheng Fu, Jingyi Wang, Ying Su, Yu-Qi Liao, Shaoling Li, Gelin Xu, Yan-Jiao Huang, Minghua Hu, Liming Cao · 发表于：World Journal of Clinical Cases · 年份：2023 · DOI：10.12998/wjcc.v11.i29.7127 · 被引用次数：22 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Intracranial Aneurysms: Treatment and Complications、Renal and Vascular Pathologies

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 (dissec...