Ultrasound guided transarterial coil placement in the internal and external carotid artery in horses.
Authors: Muñoz Juan, Iglesias Manuel, Chao Eduardo Lloret, Bussy Christian
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Guttural pouch mycosis remains a life-threatening condition in horses, and whilst transarterial coil embolisation is an effective treatment, the procedure traditionally relies on fluoroscopic guidance with its associated radiation exposure. Muñoz Juan and colleagues evaluated ultrasound-guided transarterial coil placement (UGTACP) as an alternative approach, conducting the technique on ten cadaveric specimens, three healthy horses, and one clinical case with naturally occurring left guttural pouch mycosis. Ultrasound-guided catheterisation of both the internal and external carotid arteries proved reliable in all specimens, with successful coil placement achieved in all but one case and no complications occurring in the living horses; the affected clinical case recovered fully and returned to work. The authors found UGTACP particularly valuable for occluding the caudal portions of these vessels and for identifying anatomical variations at the origin of the internal carotid artery—advantages that fluoroscopy cannot match—though they noted that fluoroscopic guidance remained superior for precise placement in the rostral internal carotid artery. For practitioners managing guttural pouch mycosis cases, this technique offers a meaningful reduction in radiation exposure when used as a hybrid approach, combining ultrasound guidance for the initial catheterisation stages with brief fluoroscopic control only when necessary for the most distal portions of the vessel.
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Practical Takeaways
- •Ultrasound-guided coil placement is a viable alternative to fluoroscopy for treating guttural pouch mycosis and other conditions requiring carotid artery occlusion, reducing radiation exposure for the patient and clinic staff
- •This technique is particularly advantageous for catheterizing the caudal portions of the ICA and ECA where ultrasound visualization is optimal and can identify anatomical variations that might not be apparent on radiographs
- •Consider using combined ultrasound and fluoroscopy guidance in clinical cases to maintain precision while minimizing radiation exposure, especially for rostral ICA work
Key Findings
- •Ultrasound-guided transarterial coil placement successfully occluded the ICA and ECA in all cadaveric specimens and 3 healthy horses with no complications
- •Ultrasound guidance enabled accurate catheterization of both ICA and ECA with ability to identify anatomical variations at vessel origins
- •One clinical case of guttural pouch mycosis was successfully treated with ICA coil placement, with complete recovery and return to intended use
- •Fluoroscopy guidance may be superior for rostral ICA coil placement, but combined US and fluoroscopy approach reduces radiation exposure time compared to fluoroscopy alone