Intraoperative Ultrasound Assessment of Carotid Endarterectomy and Carotid Stent Angioplasty

Abstract

The historically good clinical outcomes associated with carotid intervention depend on proper patient selection and the technical precision of the procedure. Ultrasonography provides an instrument for quality control following carotid intervention. 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 arterial injury. The imaging modality also provides verification of patency and documents normal low resistance flow pattern in the distal internal carotid artery. Similarly, intravascular ultrasound (IVUS) is ideally suited for monitoring carotid stent-angioplasty as this monorail catheter platform provides high-definition real-time imaging of the extracranial carotid arteries allowing for calculation of vessel diameter, selection of stent landing zones, and monitoring the procedural accuracy of stent deployment. Procedural ultrasound imaging will identify abnormalities that should be corrected in approximately 5–10% of cases. Detection and immediate repair of carotid abnormalities is associated with improved clinical outcomes similar to reconstructions judged “normal” on initial ultrasound assessment thereby offering a margin of quality assurance for these interventions even in high-risk surgical candidates.