Role of intravascular ultrasound in reducing the incidence of embolic events during carotid stenting

Aim. To determine the value of intravascular ultrasound (IVUS) in improving the dia­gnostic accuracy of detecting plaque prolapse and reducing the risk of cerebral ischemic complications of endovascular carotid revascularization.

Material and methods. Data from 173 patients who underwent endovascular carotid intervention were analyzed. The study group (n=85) included procedures using subtraction angiography and IVUS, while the control group (n=88) — procedures using subtraction angiography only. The incidence of protrusion detection, angiographic, and clinical outcomes in the intraoperative, early, and late postope­rative periods were analyzed.

Results. IVUS provided a 2667-fold higher detection rate of plaque prolapse compared with subtraction angiography (95% confidence interval: 1,009-7,051, p<0,05). The overall protrusion rate was 9,82% (n=17). Embolic debris in cerebral protective devices was detected in 37,5% of patients with single-layer stents and in 9,4% with dual-layer stents (p<0,001). The cumulative incidence of cerebral ischemic events in the study group was 1,2% versus 6,8% in the control group, reflecting a clinically significant 5,8-fold reduction (p=0,118).

Conclusion. IVUS in endovascular carotid interventions significantly increa­ses the detection rate of plaque prolapse not visualized by standard angiography and helps reduce the incidence of cerebral ischemic events. This technique re­presents an important tool for the prevention of embolic events.

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