Intravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection

Abstract

The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. The patient underwent stent angioplasty with IVUS guidance and his symptoms improved. To the authors' knowledge, this is the first report of IVUS-guided stent angioplasty of an extracranial VA dissection. It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.

Usefulness of Intravascular Ultrasonography Monitoring of Coil Embolization for Traumatic Direct Carotid-Cavernous Fistula -Case Report-

“…26) IVUS-guided stent angioplasty of an extracranial vertebral artery dissection was valuable for understanding the intravascular environment, confirming the true lumen, and evaluating stent apposition. 25) Intracranial IVUS remains challenging, and requires a device with high trackability to overcome the tortuous and long pathway to the target. More low-profile devices with better trackability are essential for further refinement of the technique.…”

Intravascular Ultrasound: Principles and Cerebrovascular Applications

“…13 One case report demonstrated the feasibility and safety of intravascular sonographyϪguided stent angioplasty of an iatrogenic extracranial vertebral artery dissection. 87 Takayama et al 88 also did not encounter any complications during the virtual histology intravascular sonography evaluation of a symptomatic intracranial right vertebral artery stenosis. Similarly, Wehman et al 9 demonstrated that the intravascular sonography mapping of a basilar artery stenosis can be safely performed.…”

“…With the conventional intravascular data, the vessel media diameter was found to be 5.9 ϫ 6 mm. 87 The plaque components were identified through the virtual histology analysis: fibrous (72%), fibrofatty (17%), necrotic core (7%), and attenuated calcium (4%) components. 87 Virtual histology intravascular sonography demonstrated the ability to identify a stable plaque and provide a better estimate of the size of the balloon-expandable stent needed for treatment.…”

“…87 The plaque components were identified through the virtual histology analysis: fibrous (72%), fibrofatty (17%), necrotic core (7%), and attenuated calcium (4%) components. 87 Virtual histology intravascular sonography demonstrated the ability to identify a stable plaque and provide a better estimate of the size of the balloon-expandable stent needed for treatment. Takayama et al 87 acknowledged that virtual histology intravascular sonography differentiated the atherosclerotic plaque causing the stenosis as being unstable or stable or containing high calcification.…”

“…Virtual histology intravascular sonography (Eagle Eye Gold, 2.9F, 20-MHz catheter; Volcano) has been used to image a percutaneous transluminal angioplasty and stent-treated symptomatic intracranial right vertebral artery stenosis to characterize the plaque and guide treatment, according to Takayama et al 87 The lesion was predilated by using a balloon catheter. With the conventional intravascular data, the vessel media diameter was found to be 5.9 ϫ 6 mm.…”