Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA.
J Neuroimaging. 2012 Oct;22(4):394-9. doi: 10.1111/j.1552-6569.2011.00651.x. Epub 2011 Sep 13.
Intravascular ultrasound (IVUS) has provided invaluable real-time information during carotid artery stenting (CAS). We present a case of IVUS-guided thrombus extraction during CAS. A 46-year-old man underwent an urgent right CAS under proximal flow reversal for embolic protection for a hemodynamically significant symptomatic near-occlusion of the internal carotid artery. IVUS was used to evaluate immediate poststenting results and identify potential thromboembolic material extruding through the tines of the stent. An intraluminal thrombus was identified with IVUS after the stent was deployed. This led to the use of a second stent in an attempt to trap the thrombus. Ultimately, the thrombus was removed with the use of a multipurpose-angled catheter under IVUS guidance. The artery reconstituted almost completely after stent placement, and the patient's condition improved significantly. IVUS identification of intraluminal thrombus allowed additional maneuvers to be performed to prevent distal embolization and postprocedure stroke.
血管内超声（IVUS）在颈动脉支架置入术（CAS）期间提供了非常有价值的实时信息。我们报告了一例在 CAS 期间进行 IVUS 引导下血栓切除术的病例。一名 46 岁男性因血流动力学意义上的症状性颈内动脉近段闭塞而行急诊右侧 CAS，并在近端血流反转下进行栓塞保护。IVUS 用于评估支架置入后的即刻结果，并识别可能通过支架叉突突出的血栓性栓塞物质。支架置入后，IVUS 识别到腔内血栓。这导致使用第二个支架试图捕获血栓。最终，在 IVUS 引导下使用多功能角形导管将血栓取出。支架置入后，动脉几乎完全重建，患者病情明显改善。IVUS 识别腔内血栓可进行额外的操作，以防止远端栓塞和术后卒中。
