Thrombus detected with HFUS after CEA

This case illustrates how High-Frequency Ultrasound (HFUS) enables more correct detection of higher-grade defects than angiography after CEA. The case is provided by the authors of the CIDAC study.

Case story

Patient information

83-year-old male, 90% left ICAS, 70% right ICAS

Intraoperative completion control with HFUS

An endarterectomy at the upper part of the internal carotid was performed. A grade 4 defect was detected with HFUS (Video 1), in comparison, angiography only showed a grade 2 defect (Image 2). The HFUS video clearly shows the thrombus in the lumen, visualized both by a cross-sectional and a longitudinal view. Based on the finding, a revision was performed and the thrombus was removed.

Post revision

A nice, clean lumen is seen after revision and Transit Time Flow Measurement was acceptable (Image 3 and 4).

Case attachments

Click images below to view.

HFUS showing a grade 4 defect

HFUS showing a grade 4 defect

image of endarterectomy procedure

Angio showing only grade 2 defect

Angio showing only grade 2 defect

Ultrasound image capture during medical procedure

HFUS showing a clean lumen post revision

HFUS showing a clean lumen post revision

TTFM reading

TTFM post revision

TTFM post revision

Video 1

Video 1

image of endarterectomy procedure
Image 2

Image 2

Ultrasound image capture during medical procedure
Image 3

Image 3

TTFM reading
Image 4

Image 4

Reference

CIDAC study:

“Prospective Comparison of Duplex Ultrasound and Angiography for Intraoperative Completion Studies after Carotid Endarterectomy.”

Christoph Knappich, Sofie Schmid, Pavlos Tsantilas, Michael Kallmayer, Michael Salvermoser, Alexander Zimmermann, Hans-Henning Eckstein *. Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Eur J Vasc Endovasc Surg (2020) 59, 881- 889.

Technology used

Medistim MiraQ™ Vascular System with Vascular TTFM Probes and L15 High-Frequency Ultrasound Probe.

HFUS showing a grade 4 defect

HFUS showing a grade 4 defect

image of endarterectomy procedure

Angio showing only grade 2 defect

Angio showing only grade 2 defect

Ultrasound image capture during medical procedure

HFUS showing a clean lumen post revision

HFUS showing a clean lumen post revision

TTFM reading

TTFM post revision

TTFM post revision