Successful intravascular ultrasonography-assisted carotid artery stenting for iatrogenic carotid artery dissection: Illustrative case

Abstract

Objective: Intravascular ultrasonography (IVUS) is the gold standard for evaluating plaque, lumen, and vessel dimensions. Iatrogenic internal carotid artery (ICA) dissection is a well-known complication of mechanical thrombectomy for acute stroke. Carotid artery stenting (CAS) is used to treat medically intractable lesions. Thus, IVUS-assisted CAS can be an effective treatment option for preventing intraoperative complications and stroke recurrence in patients with iatrogenic ICA dissection. Case presentation: An 85-year-old woman presented with right hemiplegia and aphasia. Magnetic resonance angiography revealed left ICA occlusion, and she underwent mechanical thrombectomy with an aspiration catheter and stent retriever. Thrombolysis in cerebral infarction 2b recanalization was achieved; however, the cervical ICA showed severe stenosis and dissection. Since the cervical lesion was not sufficiently dilated through percutaneous transluminal angioplasty, we decided to perform CAS. The proximal and distal ends of the dissection cavity were confirmed using IVUS, allowing the stent to be placed in the appropriate position. She had no postoperative complications and was transferred to a rehabilitation hospital with a modified Rankin Scale score of 4. Conclusion: This case demonstrates that IVUS is useful for determining and confirming the stent position in patients with iatrogenic ICA dissection.

Keywords

• Carotid artery
• Case report
• Dissection
• Intravascular ultrasonography
• Stenting