The value of intravascular ultrasound-facilitated internal carotid artery stenting in a patient with heavily calcified and ambiguous common carotid artery stenosis

Percutaneous transluminal carotid artery stenting (CAS) is a promising new treatment option for carotid artery stenosis. These procedures are currently performed in high-risk patients and have demonstrated favorable outcomes. We described the use of intravascular ultrasound (IVUS) to facilitate internal carotid artery stenting in a patient with heavily calcified and ambiguous common carotid artery stenosis. The common carotid artery angiogram revealed 50% stenosis, but IVUS of the common carotid demonstrated a 90% stenosis with complex superficial calcification. Protrusion of the superficial calcification inside the common carotid artery which was demonstrated by IVUS has not only created a difficulty to deliver the stent to the internal carotid artery, but also left the common carotid artery lesion untreated, which is not likely to achieve clinical the benefit of internal carotid stenting. IVUS was an indispensable tool for a procedural success in this case.