Intravascular ultrasound-guided thrombus retrieval with a multipurpose-angled catheter during carotid artery stenting

Intravascular ultrasound (IVUS) has provided invaluable real-time information during carotid artery stenting (CAS). We present a case of IVUS-guided thrombus extraction during CAS. A 46-year-old man underwent an urgent right CAS under proximal flow reversal for embolic protection for a hemodynamically significant symptomatic near-occlusion of the internal carotid artery. IVUS was used to evaluate immediate poststenting results and identify potential thromboembolic material extruding through the tines of the stent. An intraluminal thrombus was identified with IVUS after the stent was deployed. This led to the use of a second stent in an attempt to trap the thrombus. Ultimately, the thrombus was removed with the use of a multipurpose-angled catheter under IVUS guidance. The artery reconstituted almost completely after stent placement, and the patient's condition improved significantly. IVUS identification of intraluminal thrombus allowed additional maneuvers to be performed to prevent distal embolization and postprocedure stroke.