Facial and neck hematoma after carotid artery stenting: an uncommon misadventure in endovascular carotid revascularization

Real time artificial intelligence assisted carotid artery stenting: a preliminary experience

BACKGROUND

Neurointerventionalists must pay close attention to multiple devices on multiple screens simultaneously, which can lead to oversights and complications. Artificial intelligence (AI) has potential application in recognizing and monitoring these devices on fluoroscopic imaging.

METHODS

We report out preliminary experience with a real time AI assistance software, Neuro-Vascular Assist (iMed technologies, Tokyo, Japan), in six patients who underwent carotid artery stenting. This software provides real time assistance during endovascular procedures by tracking wires, guiding catheters, and embolic protection devices. The software provides notification when devices move out of a predefined region of interest or off the screen during the procedure. Efficacy, safety, and accuracy of the software were evaluated.

RESULTS

The software functioned well without problems and was easily used. Mean number of notifications per procedure was 21.0. The mean numbers of true positives, false positives, and false negatives per procedure were 17.2, 3.8, and 1.2, respectively. Precision and recall were 82% and 94%, respectively. Among the 103 true positive notifications, 24 caused the operator to adjust the inappropriate position of the device (23%), which is approximately four times per procedure. False notifications occurred because of false positive device detection. No adverse events related to the software occurred. No periprocedural complications occurred.

CONCLUSIONS

Neuro-Vascular Assist, a real time AI assistance software, worked appropriately and may be beneficial in carotid artery stenting procedures. Future large scale studies are warranted to confirm.

Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions

Carotid endarterectomy and carotid artery stenting are among the most common peripheral vascular procedures performed worldwide. Sonography is the initial and often only imaging modality used in the evaluation of iatrogenic carotid arterial injuries. This pictorial essay provides an overview of the clinical and sonographic findings of complications after interventions in the extracranial carotid arteries, including dissection, fluid collections, pseudoaneurysm, thrombosis, thromboembolism, restenosis, and stent deformation. Grayscale, color, and pulsed Doppler imaging findings are reviewed, and correlations with computed tomography, magnetic resonance imaging, and angiography are provided.

Perforation of superior thyroid artery by guidewire during carotid artery stenting

BACKGROUND AND AIM

Although carotid artery stenting (CAS) has become a common treatment for carotid artery stenosis, some complications occur related to the procedures. Perforation of an external carotid artery (ECA) branch is a rare complication.

CASE DESCRIPTION

An 83-year-old man presented with gait disturbance and dysarthria. MRI demonstrated a fresh cerebral infarction in the watershed territory of the left cerebrum and severe stenosis of the left internal carotid artery (ICA). He underwent CAS for the left ICA stenosis. After the procedure, the patient complained of discomfort of the throat. Swelling of the neck was observed and angiography showed extravasation of contrast medium from the superior thyroid artery. The patient was immediately sedated and intubated. Strict control of the blood pressure was continued. Two days after CAS, the tracheal tube was extracted. He was discharged without deficit on the 17th post-stenting day.

CONCLUSION

Injury of ECA branches is a potential complication when a guidewire is inserted during advancement of the materials. It may be life threatening due to associated respiratory problems. Once bleeding from the ECA is suspected, close observation of the patient's neck and respiration and immediate intervention are necessary.