5th International Conference on Heart and Cardiovascular Diseases

Alexander Korobkov is currently in the process of defending his thesis for the degree of Candidate of Medical Sciences (equivalent to a PhD) at the Petrovsky National Research Centre of Surgery. He currently heads the Vascular Center at JSC "Medicina" (Academician Roytberg’s Clinic). He has authored over 30 publications that have been cited more than 30 times, and holds an h-index of 3. He also serves as the scientific secretary of YIRESA, a non-profit association of interventional radiologists, where he regularly organizes scientific and practical workshops and conferences.

Background:

Plaque protrusion through stent struts may contribute to cerebral embolization during carotid artery stenting (CAS) and may be missed by angiography.

Objectives:

To assess the value of intravascular ultrasound (IVUS) for detecting plaque protrusion and reducing cerebral ischemic complications during CAS.

Methodology:

This retrospective observational study included 173 patients treated at two vascular centers during 2013–2019 and 2020–2023. CAS was guided by IVUS plus angiography in 85 patients and angiography alone in 88. All procedures used cerebral protection devices. Plaque protrusion, embolic debris, and cerebral ischemic complications through 30 days were assessed. IVUS-detected protrusions prompted additional balloon postdilation or stent-in-stent implantation. Key Results/Findings: Plaque protrusion was detected in 17/173 patients (9.82%): 13/85 (15.29%) in the IVUS group and 4/88 (4.55%) in the control group. Seven protrusions were detected exclusively by IVUS. Postdilation reduced protrusion in 12/13 IVUS-group cases (92.3%); one required an additional stent. Embolic debris was found in 37.5% of patients with single-layer stents versus 9.4% with double-layer stents (p < 0.001). Cerebral ischemic complications occurred in 1/85 patients (1.2%) with IVUS versus 6/88 (6.8%) with angiography alone (p = 0.118). No intraoperative neurological events occurred in the IVUS group.

Conclusion:

IVUS identified plaque protrusions not visualized by angiography and enabled targeted intraoperative correction. Cerebral ischemic complications were numerically less frequent with IVUS, but the difference was not statistically significant. These findings suggest a potential role for IVUS in preventing embolic events during CAS.