Safety and Feasibility of Carotid Artery Stenting with Dual-Echo Technique to Minimize Iodinated Contrast Dose

Abstract

The aim of this study was to evaluate the safety and feasibility of carotid artery stenting (CAS) employing dual-ultrasound technique and administering a minimal contrast agent in patients with renal insufficiency. Between September 2009 and July 2013, 63 consecutive patients underwent CAS at our institution: dual-echo carotid artery stenting (DECAS) in 7 patients with renal insufficiency and standard carotid artery stenting (STCAS) in the remaining 56 patients. Periprocedural adverse events and outcomes were compared between the 2 groups. Technical success was achieved in all cases. The 3 procedure-related complications were 1 case of transient hemiparesis in the DECAS group and 1 transient and 1 permanent case of hemiparesis in the STCAS group. The rate of positive diffusion-weighted-imaging lesions did not differ significantly between the 2 groups (28.6% versus 12.5%, P = .26). A significantly smaller volume of contrast was used in DECAS (15 versus 163 mL, P < .01). The change in creatinine level remained stable after CAS and did not differ between the 2 groups (.02 versus .03 mg/dL, P = .96). DECAS is safe and feasible for patients with pre-existing renal insufficiency and can provide an alternative for patients with carotid stenosis and renal insufficiency.