Distal extracranial ICA stenting: a novel non-invasive US follow-up with transcranial probe

Purpose: Distal extracranial internal carotid artery (ICA) follow-up after stenting could be challenging because of tortuosity and anatomic limitations, requiring second-line invasive exams (CT-Angiography, Digital Subtraction Angiography). Aim of our study was to validate a new diagnostic ultrasound modality, using a transcranial probe, for evaluation of distal cervical ICA segment after endovascular stenting. Methods: From January 2022 to February 2024, all patients stented for high extracranial carotid disease in acute or elective setting were retrospectively enrolled. Three-month US follow-up was obtained with linear and transcranial probes (TP). CTA and DSA were used as standard of reference. Results: A total of 46 patients in which high ICA stenting was performed were included. Emergency carotid stenting was obtained in 69,5%. For evaluation of stent patency, TP demonstrated a sensibility and specificity respectively of 100% and 97,4%. For intrastent stenosis/decoupling in overlapping stents or pseudoaneurysm exclusion, TP demonstrated a sensibility and specificity respectively of 66,7% and 97,4%. Conclusion: US evaluation using transcranial probe with submandibular approach could be a novel, noninvasive method for stenting follow-up in distal extracranial ICA.