Key result
Angioscopy reveals in-stent plaque protrusion and fluttering debris missed by IVUS and OCT.
Why the study?
Assessment of plaque morphology during carotid artery stenting is important to evaluate ischemic risk, but current imaging modalities provide indirect visualization and may miss fluttering plaques.
Does the use of angioscopy improve the intraprocedural evaluation of plaque protrusion during carotid artery stenting?
Case Report (n=1)
No
Does the use of angioscopy improve the intraprocedural evaluation of plaque protrusion during carotid artery stenting?
Intraprocedural angioscopy during carotid stenting can directly visualize fluttering debris and plaque protrusion that may be difficult to assess using indirect imaging modalities like IVUS and OCT.
Objective: A case in which angioscopy was useful for the evaluation of plaque protrusion during carotid artery stenting (CAS) is reported. Case Presentations: The patient was a 67-year-old man. He presented with transient ischemic attacks and progression of bilateral internal carotid artery stenosis during a course of about 7 months. CAS was performed with dual protection using flow reversal system (modified Parodi method) and FilterWire EZ (Boson Scientific, Natick, MA, USA). After stent placement, plaque protrusion was detected by intravascular ultrasonography (IVUS) and optimal coherence tomography (OCT), and plaque protrusion and fluttering debris were also noted by angioscopy. Therefore, additional stenting was performed. Although the evaluation was difficult by subsequent IVUS or OCT, angiosopy revealed plaque protrusion and fluttering debris were both confirmed to be immobilized by the stents. Conclusion: Since the vascular and stent lumens could be evaluated directly by the use of angioscopy, it may be useful for the examination of plaques and plaque protrusions particularly when multiple stents have been used.
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Kondo et al. (2017) conducted a case report in Internal carotid artery stenosis (n=1). Angioscopy during carotid artery stenting was evaluated on Detection of plaque protrusion and fluttering debris. Direct angioscopic visualization detected plaque protrusion and fluttering debris inside the stent that were difficult to evaluate by IVUS or OCT, prompting placement of an additional stent.
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