Intraoperative Ultrasound Assessment of Carotid Endarterectomy and Stent-Angioplasty

Abstract

The outcome of carotid interventions depends on technical precision of the arterial repair which can be assessed accurately using ultrasound imaging. Following carotid endarterectomy, duplex ultrasound provides both anatomic (real-time B-mode imaging) and hemodynamic (pulsed Doppler spectral analysis) assessment of the repair, allowing detection of residual stenosis, lumen debris, plaque dissection, and verification of normal low resistance flow in the distal internal carotid artery. Intravascular ultrasound is suited for monitoring carotid stent-angioplasty as the over-the-wire catheter provides high-resolution real-time imaging of the extracranial carotid artery for vessel diameter measurements, selection of stent landing zones, and alerting the interventionist to incomplete stent expansion (residual stenosis) or other abnormalities such as lumen thrombus or vessel dissection proximal or distal to the stent. Intraprocedural ultrasound imaging will identify abnormalities that should be corrected in approximately 5–10% of cases. Detection and immediate repair of detected abnormalities is associated with clinical outcomes similar to reconstructions judged “normal” on initial ultrasound assessment, including perioperative neurologic events and reintervention for restenosis.