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Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

We aimed to investigate the safety and feasibility of duplex-assisted carotid artery stenting (CAS) without administration of contrast medium for the prevention of adverse reactions.

Methods

Fifteen patients (9 % of all CASs) with severe carotid stenosis (≥70 %) associated with chronic kidney disease (CKD) (stage ≥3) or allergy to contrast medium underwent duplex-assisted CAS without administration of contrast medium over 4 years. The procedural success rate and perioperative complication rates were compared between the duplex-assisted CAS (n = 15) and conventional CAS (n = 153) groups.

Results

The technical success rate was 100 % in both groups. Combined stroke or death rates during the post-procedural period did not differ significantly between the duplex-assisted CAS group (0/15, 0 %) and conventional CAS group (4/153, 2.6 %). None of the 14 patients with CKD in the duplex-assisted CAS group experienced further deterioration of renal function. The mean surface radiation dose of participants in the duplex-assisted CAS group (n = 13, 312 ± 131 mGy) was significantly lower than that of the conventional CAS group (n = 31, 1036 ± 571 mGy) (p < 0.001). The mean duration of CAS procedure was not significantly different between the duplex-assisted CAS group (156 ± 39.7 min) and the conventional CAS group (156 ± 37.4 min).

Conclusion

Duplex-assisted CAS without administration of contrast medium could be an alternative option in selected patients deemed to be at high risk for renal failure from nephrotoxic contrast medium or who have an allergy to contrast medium.

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Abbreviations

CAS:

Carotid artery stenting

CEA:

Carotid endarterectomy

CKD:

Chronic kidney disease

CIN:

Contrast medium-induced nephropathy

DM:

Diabetes mellitus

eGFR:

Estimated glomerular filtration rate

ICA:

Internal carotid artery

PSV:

Peak systolic velocity

EPD:

Embolic protection device

FLAIR:

Fluid-attenuated inversion recovery

DWI:

Diffusion weighted imaging

MRA:

Magnetic resonance angiography

CCA:

Common carotid artery

IVUS:

Intravascular ultrasound

DS:

Duplex sonography

GC:

Guiding catheter

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Acknowledgments

We would like to express our gratitude to Keiko Fukuoka, Tsumugi Oki, Yumiko Kanou, Ryu Seong Yi, Yumiko Kano and Takamitsu Imanishi in the physiological laboratory for continuing support. This work was partially supported by Grants-in-Aid for Scientific Research (C) KAKENHI Number 25462216 from the Japan Society for the Promotion of Science.

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Authors and Affiliations

  1. Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Takashi Mizowaki, Atsushi Fujita, Taichiro Imahori, Atsushi Uyama, Satoshi Inoue, Masaaki Kohta, Takashi Sasayama, Kohkichi Hosoda & Eiji Kohmura

  2. Department of Neurology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan

    Hirotoshi Hamaguchi

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  1. Takashi Mizowaki
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  2. Atsushi Fujita
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  3. Taichiro Imahori
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  4. Atsushi Uyama
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  5. Satoshi Inoue
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  8. Takashi Sasayama
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  9. Kohkichi Hosoda
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Corresponding author

Correspondence to Takashi Mizowaki.

Ethics declarations

We declare that all human studies have been approved by the institutional review board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent, or consent was given by the patient’s nearest relatives in the event patients did not have the capacity to consent, prior to inclusion in this study.

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We declare that we have no conflict of interest.

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Mizowaki, T., Fujita, A., Imahori, T. et al. Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction. Neuroradiology 58, 679–686 (2016). https://doi.org/10.1007/s00234-016-1678-x

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  • DOI: https://doi.org/10.1007/s00234-016-1678-x

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