Carotid artery stenting (CAS) is a viable alternativetreatment to carotid endarterectomy. Stroke is one ofthe most important complications of CAS and is mostlycaused by intraprocedural distal embolization of plaquecomponents.1 In order to prevent procedure-relatedcerebrovascular accidents, a careful assessment of carotidplaque morphology is required. Large studies demonstrated that necrotic core, mainly ifsuperficial and surrounded by a thin or ruptured fibrouscap, is the predominant histological finding in carotidplaque related to cerebrovascular accidents.2 So, it isfundamental to have a technique able to identify vulnerable and prone to rupture...

Patient selection A randomized prospective evaluation was performed on60 Patients at high surgical risk who underwent CASduring a 14-month period.The institutional review board at our institution fullyapproved the treatment protocol. All eligible patientswere invited to participate in the study with an informationletter. On the basis of the written and spokeninformation, the patient made the decision whether ornot to join the study. The informed consent was obtainedfrom each participating patient. Patients were informedof their right to withdraw from the study at any time. The study was...

Technical success was achieved in all patients. The VHIVUSevaluation performed after stent deploymentshowed a not optimal stent-to-wall apposition, whichwas not evident at the fluoroscopic evaluation, in two patients (3%), leading to a postdilation (Fig. 1).The VH-IVUS evaluation led to a stent type change inthree patients (5%): two close-to-open cell, one open-toclosecell. After VH-IVUS plaque evaluation stentchanges in size and/or length were not required in anycase.In one Patient, during after-stenting VH-IVUS evaluation,an intraluminal lesion at the distal third of the stentwas observed. This lesion presented ultrasonographiccharacteristics...

Although not recommendable as a routine evaluationduring CAS, IVUS may result useful for the real-timecontrol of CAS of challenging plaques such as ‘soft’,lipidic or prone to rupture ones, or whenever an intraproceduralmorphologic evaluation is required for thechoice of the appropriate stent type, and the preventionof embolic complications.

1 Wehman JC, Holmes DR, Ecker D, et al. Intravascular ultrasound identification of intraluminal embolic plaque material during carotid angioplasty with stenting. Catheter Cardiovasc Intervent 2006; 68:853– 857. 2 Inglese L, Fantoni C, Saradana V. Can IVUS virtual-histolgy improve outcomes in percutaneous carotid treatment? J Cardiovasc Surg 2009; 50:735–744. 3 Diethrich EB, Ndiaye M, Reid DB. Stenting in the carotid artery: initial experience in 110 patients. J Endovasc Surg 1996; 3:42–62. 4 Biasi GM, Mingazzini PM, Baronio L, et al. Carotid plaque charecterization using digital...