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Transcarotid Artery Revascularization: The Role Of Intravascular Ultrasound
Tian Sheng Ng, MD
1, Vikram Bhatt, MD
1, Benjamin Dahlberg, MD
1, Nicole Taylor, MD
1, Sean Ramros, MD
2, Robert K. Botta, MD
3, Moqueet Arshad Qureshi, MD
3, Jamie S. Strachan, MD
3.
1Saint Mary's Hospital Waterbury, Waterbury, CT, USA,
2Waterbury Hospital, Waterbury, CT, USA,
3The Vascular Experts, Waterbury, CT, USA.
OBJECTIVES: Intravascular Ultrasound (IVUS) has been utilized as an imaging modality to enhance procedural precision and outcomes in various endovascular procedures. In standard TransCarotid Artery Revascularization (TCAR), fluoroscopy has been utilized to visualize carotid lesions and guide stent placement. Introducing IVUS in TCAR provides real-time, high-resolution cross-sectional images, allowing for accurate assessment of plaque morphology, luminal dimensions, and vessel architecture. The aim of this study was to analyze the outcomes of TCAR utilizing IVUS and to assess the benefits of this imaging modality.
METHODS: We report a cohort of 42 patients who underwent TCAR from February, 2022 to May, 2024. We routinely use IVUS during TCAR. Post stent angioplasty, amount of contrast use, fluoroscopy time, flow reversal time, TCAR procedure time, along with postoperative ipsilateral stroke and myocardial infarction were studied.
RESULTS: 35.7% of patients (15/42) had symptomatic carotid stenosis. 66.7% of the patients (28/42) underwent post stent angioplasty due to residual stenosis and poor apposition. The average contrast needed for TCAR was 5.5ml (2 - 14ml). The average fluoroscopy time required was 9.66 minutes (3 - 17minutes). Flow reversal time was averaged at 18.29 minutes (10 - 57 minutes). The average TCAR procedure time was 84.67 minutes (56 - 150 minutes) Arterial dissection was detected in 4.8% of the patients (2/42) and was treated by additional stent extension. 2.4% of the patients (1/42) had a non-debilitating ipsilateral stroke within 30 days post TCAR. None of the patients experienced postoperative MI within 30 days.
CONCLUSIONS: Routine IVUS during TCAR does not increase periprocedural stroke rate. Detailed visualization aids in the optimal selection and deployment of stents, ensuring proper apposition and reducing the risk of complications. It also minimizes contrast usage and decreases the associated risk of stroke secondary to air embolization. It allows earlier detection of suboptimal stent deployment, residual vessel stenosis and arterial dissection.
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