Int J Angiol 2015; 24(03): 185-188
DOI: 10.1055/s-0035-1556081
Invited Paper
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Utilization of Intravascular Ultrasound during Carotid Artery Stenting

Elizabeth Hitchner
1   Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, California
Wei Zhou
1   Division of Vascular Surgery, VA Palo Alto Health Care System, Palo Alto, California
2   Division of Vascular Surgery, Stanford University, Stanford, California
› Institutsangaben
Weitere Informationen


10. Juli 2015 (online)


For patients at high risk for surgery, carotid artery stenting (CAS) is a viable alternative to help reduce risk of stroke for patients with high-grade carotid artery stenosis; however, a higher incidence of perioperative stroke has been observed in patients undergoing stenting compared to those undergoing open surgery. Intravascular ultrasound (IVUS) is commonly used during coronary artery procedures to help evaluate lesions and to guide stent placement. Multiple groups have sought to determine whether IVUS could also be used during CAS. While IVUS has been shown to be both feasible and safe during CAS, there is limited evidence that demonstrates direct improvement in procedural outcomes. Further studies focusing on clinical outcomes should be conducted in order to justify routine use of this technology during CAS.

  • References

  • 1 Brott TG, Hobson II RW, Howard G , et al; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363 (1) 11-23
  • 2 Mozaffarian D, Benjamin EJ, Go AS , et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation 2015; 131: e29-e322
  • 3 Bonati LH, Jongen LM, Haller S , et al; ICSS-MRI study group. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010; 9 (4) 353-362
  • 4 Tedesco MM, Lee JT, Dalman RL , et al. Postprocedural microembolic events following carotid surgery and carotid angioplasty and stenting. J Vasc Surg 2007; 46 (2) 244-250
  • 5 Zhou W, Hitchner E, Gillis K , et al. Prospective neurocognitive evaluation of patients undergoing carotid interventions. J Vasc Surg 2012; 56 (6) 1571-1578
  • 6 Pieniazek P, Musialek P, Kablak-Ziembicka A , et al. Carotid artery stenting with patient- and lesion-tailored selection of the neuroprotection system and stent type: early and 5-year results from a prospective academic registry of 535 consecutive procedures (TARGET-CAS). J Endovasc Ther 2008; 15 (3) 249-262
  • 7 Verhoeven B, Hellings WE, Moll FL , et al. Carotid atherosclerotic plaques in patients with transient ischemic attacks and stroke have unstable characteristics compared with plaques in asymptomatic and amaurosis fugax patients. J Vasc Surg 2005; 42 (6) 1075-1081
  • 8 Diethrich EB, Pauliina Margolis M, Reid DB , et al. Virtual histology intravascular ultrasound assessment of carotid artery disease: the Carotid Artery Plaque Virtual Histology Evaluation (CAPITAL) study. J Endovasc Ther 2007; 14 (5) 676-686
  • 9 Lee JT, White RA. Basics of intravascular ultrasound: an essential tool for the endovascular surgeon. Semin Vasc Surg 2004; 17 (2) 110-118
  • 10 Bandyk DF, Armstrong PA. Use of intravascular ultrasound as a “Quality Control” technique during carotid stent-angioplasty: are there risks to its use?. J Cardiovasc Surg (Torino) 2009; 50 (6) 727-733
  • 11 Hitchner E, Zayed MA, Lee G, Morrison D, Lane B, Zhou W. Intravascular ultrasound as a clinical adjunct for carotid plaque characterization. J Vasc Surg 2014; 59 (3) 774-780
  • 12 Irshad K, Millar S, Velu R, Reid AW, Diethrich EB, Reid DB. Virtual histology intravascular ultrasound in carotid interventions. J Endovasc Ther 2007; 14 (2) 198-207
  • 13 Wehman JC, Holmes Jr DR, Ecker RD , et al. Intravascular ultrasound identification of intraluminal embolic plaque material during carotid angioplasty with stenting. Catheter Cardiovasc Interv 2006; 68 (6) 853-857
  • 14 Clark DJ, Lessio S, O'Donoghue M, Schainfeld R, Rosenfield K. Safety and utility of intravascular ultrasound-guided carotid artery stenting. Catheter Cardiovasc Interv 2004; 63 (3) 355-362
  • 15 Sangiorgi G, Bedogni F, Sganzerla P , et al. The Virtual histology In CaroTids Observational RegistrY (VICTORY) study: a European prospective registry to assess the feasibility and safety of intravascular ultrasound and virtual histology during carotid interventions. Int J Cardiol 2013; 168 (3) 2089-2093
  • 16 Schiro BJ, Wholey MH. The expanding indications for virtual histology intravascular ultrasound for plaque analysis prior to carotid stenting. J Cardiovasc Surg (Torino) 2008; 49 (6) 729-736
  • 17 Inglese L, Fantoni C, Sardana V. Can IVUS-virtual histology improve outcomes of percutaneous carotid treatment?. J Cardiovasc Surg (Torino) 2009; 50 (6) 735-744
  • 18 Politi L, Aprile A, Rollini F , et al. Carotid plaque characterisation by IVUS-VH during carotid stenting: the “eyes wide shut” between plaque morphology and symptoms. Minerva Cardioangiol 2011; 59 (6) 591-600
  • 19 Hitchner E, Zayed M, Varu V, Lee G, Aalami O, Zhou W. A prospective evaluation of using IVUS during percutaneous superficial femoral artery interventions. Ann Vasc Surg 2015; 29 (1) 28-33
  • 20 Timaran CH, Rosero EB, Martinez AE, Ilarraza A, Modrall JG, Clagett GP. Atherosclerotic plaque composition assessed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg 2010; 52 (5) 1188-1194
  • 21 Matsumoto S, Nakahara I, Higashi T , et al. Fibro-fatty volume of culprit lesions in Virtual Histology intravascular ultrasound is associated with the amount of debris during carotid artery stenting. Cerebrovasc Dis 2010; 29 (5) 468-475
  • 22 Yamada K, Yoshimura S, Kawasaki M , et al. Prediction of silent ischemic lesions after carotid artery stenting using virtual histology intravascular ultrasound. Cerebrovasc Dis 2011; 32 (2) 106-113
  • 23 González A, López-Rueda A, Gutiérrez I , et al. Carotid plaque characterization by virtual histology intravascular ultrasound related to the timing of carotid intervention. J Endovasc Ther 2012; 19 (6) 764-773
  • 24 Tsurumi A, Tsurumi Y, Hososhima O, Matsubara N, Izumi T, Miyachi S. Virtual histology analysis of carotid atherosclerotic plaque: plaque composition at the minimum lumen site and of the entire carotid plaque. J Neuroimaging 2013; 23 (1) 12-17
  • 25 Siewiorek GM, Loghmanpour NA, Winston BM, Wholey MH, Finol EA. Reproducibility of IVUS border detection for carotid atherosclerotic plaque assessment. Med Eng Phys 2012; 34 (6) 702-708
  • 26 Mintz GS, Nissen SE, Anderson WD , et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001; 37 (5) 1478-1492