# Distal Extracranial Internal Carotid Artery Stenting: A Novel Non-invasive Ultrasound Follow-Up With a Transcranial Probe

## TL;DR

This study introduces a new non-invasive ultrasound method using a transcranial probe to monitor the distal internal carotid artery after stenting, reducing the need for more invasive imaging techniques.

## Contribution

The study validates a novel transcranial ultrasound approach for evaluating distal ICA stents, offering a non-invasive alternative to CT angiography and digital subtraction angiography.

## Key findings

- Transcranial probe demonstrated 100% sensitivity and 97.4% specificity for stent patency evaluation.
- The method showed 66.7% sensitivity and 97.4% specificity for detecting intrastent stenosis or pseudoaneurysms.
- The submandibular approach with a transcranial probe proved effective for follow-up in 46 patients with high ICA stenting.

## Abstract

Introduction: Distal extracranial internal carotid artery (ICA) follow-up after stenting could be challenging because of tortuosity and anatomic limitations, requiring second-line invasive exams such as CT angiography (CTA) and digital subtraction angiography (DSA). The aim of our study was to validate a new diagnostic ultrasound (US) modality, using a transcranial probe (TP), for the evaluation of the distal cervical ICA segment after endovascular stenting.

Methods: From January 2022 to February 2024, all patients stented for high extracranial carotid disease in an acute or elective setting were retrospectively enrolled. A three-month US follow-up was conducted with linear and transcranial probes. CTA and DSA were used as a standard of reference.

Results: A total of 46 patients in whom high ICA stenting was performed were included. Emergency carotid stenting was performed in 69.5%. For the evaluation of stent patency, TP demonstrated a sensitivity and specificity of 100% and 97.4%, respectively. For intrastent stenosis/decoupling in overlapping stents or pseudoaneurysm exclusion, TP demonstrated a sensitivity and specificity of 66.7% and 97.4%, respectively.

Conclusion: US evaluation using a TP with submandibular approach could be a novel, non-invasive method for stenting follow-up in distal extracranial ICA.