Duplex and contrast enhanced ultrasound (CEUS) in evaluation of in-stent restenosis after carotid stenting.

PURPOSE

The aim of the study was to evaluate whether contrast enhanced ultrasound (CEUS) can improve the visualization of in-stent restenosis after carotid stenting of the internal carotid artery (ICA) in comparison to color-coded duplex sonography (CCDS) and power Doppler.

MATERIAL AND METHODS

The study included the follow up of thirty patients after carotid artery stenting (CAS). Intrastenotic flow detection and lengths of in-stent restenosis were the main criteria. A high-end ultrasound machine (Siemens, ACUSON, Sequoia or S2000) with a multi-frequency linear 9 MHz or 15 MHz transducer was used to carry out contrast-enhanced ultrasound with SonoVue. In cases of treatment of a high degree in-stent stenosis intra-arterial digital subtraction angiography (DSA) was used.

RESULTS

All patients were examined using all diagnostic ultrasound tools of the study. In five patients (17%) an in-stent restenosis of the internal carotid artery (ICA) was found. Two patients need a reintervention. The results show that the contrast enhanced ultrasound could improve the diagnostic assessment capabilities in comparison to CCDS and power Doppler for patients with in-stent restenosis after carotid stenting of the ICA.

CONCLUSION

Contrast enhanced ultrasound is a reliable method for the evaluation of in-stent restenosis after carotid stenting of the ICA. CEUS provides a reduction in intrastenotic flow artefacts, resulting in better visualisation and detection of the complete length of the stenosis in comparison with CCDS and power Doppler. In order to elucidate hemodynamic changes, additional Doppler examinations are still necessary.