Duplex-assisted internal carotid artery balloon angioplasty and stent placement.

Carotid artery balloon angioplasty and stenting (CBAS) is gaining popularity as an adequate alternative to carotid endarterectomy (CEA) in selected patients. Unfortunately, the substantial amount of contrast media used for CBAS, traditionally performed under fluoroscopic guidance, may impair renal function in patients with diabetes or ones with elevated serum creatinine. We attempted to apply duplex assistance to limit or eliminate the use of contrast during CBAS. Fluoroscopy was utilized to assist manipulation of the guidewire into the aorta and the common carotid artery, and positioning of the distal cerebral protection device. Selective catheterization of the internal and external carotid arteries was performed under ultrasound guidance. Balloons and stent were successfully deployed with ultrasound guidance alone in all cases. Appropriate stent apposition and arterial patency were confirmed by duplex in all cases. One ipsilateral stroke (2.9%) occurred intraoperatively with almost complete clinical recovery in 4 months. On-table biplanar cerebral arteriogram performed in this patient was normal. No early (30-day) mortalities were in the series. Duplex-assisted CBAS is feasible and may reduce the need for contrast media in selected patients with high risk for renal failure. Additional advantages include guidance of the femoral puncture, precise position of the balloon and stent and B-mode and hemodynamic confirmation of the adequacy of the technique.