The aim of this study was to investigate the safety and effectiveness of endovascular stenting for extracranial carotid artery aneurysms (ECAAs) and evaluate the mid-term outcomes.Twelve consecutive symptomatic patients (mean age 43.8 ± 14.9 years; 8 men) with ECAAs who were treated with endovascular stenting between 1997 and 2015 were retrospectively analyzed. Clinical follow-up data including symptoms and neurological events were obtained from outpatient records. Imaging follow-up with duplex ultrasound and/or computed tomographic angiography (CTA) was performed to examine the aneurysm obliteration and patency of the stents at 3, 6, 12 months and yearly thereafter.A total of 5 true aneurysms and 7 pseudoaneurysms were included in our series. Neurological symptoms (n = 5, 41.7%) and a pulsatile neck mass (n = 5, 41.7%) were the most common presenting symptoms. Endovascular stenting procedures were technically successful in all cases; 3 patients received bare stents, and 9 patients received covered stents. No perioperative neurologic or cardiopulmonary complications occurred. Over a period of follow-ups (mean 21.8 ± 25.1 months), all patients were alive and free from neurological or other adverse events. All aneurysms were completely excluded except for 1 patient who was exposed to a residual medium leaking into the aneurysm sac. No reintervention was performed in this specific patient because aneurysm growth or significant clinical symptoms did not occur. Recurrent restenosis assessed by CTA imaging at 12 months occurred in 1 (8.3%) patient in our series. Target lesion revascularization for this hemodynamic restenosis was treated with placement of an additional stent.In our series, endovascular stenting for ECAAs was found to be safe, effective, and proved to have promising mid-term results. Although long-term results need to be further explored, advantages including less procedure-related complications and a shorter recovery time make endovascular stenting an attractive option for ECAAs, especially for the patients who are unfit for traditional open surgery.
In this single-institutional experience, both operative and endovascular interventions for ECCAs provided acceptable early and 5-year results. The endovascular approach had significantly less cranial nerve injury and shorter length of hospital stay.
Atherosclerosis is the major pathophysiological basis of cerebrovascular and cardiovascular diseases. Vascular smooth muscle cells (VSMCs) constitute the main structure of vasculature and play important roles in maintaining vascular tone and blood pressure. Many biological processes and cellular signaling events involved in atherosclerogenesis have been shown to converge on deregulating VSMC functions. However, the molecular mechanisms underlying dysfunctional VSMC in atherosclerosis are still poorly defined. Recent evidence revealed that circular RNAs (circRNAs) are closely related to diseases such as degenerative diseases, tumor, congenital diseases, endocrine diseases and cardiovascular diseases. Several studies demonstrated that circRNAs (e.g., circACTA2, Circ-SATB2, circDiaph3, circ_0020397, circTET3, circCCDC66) played critical roles in the regulation of VSMC proliferation, migration, invasion, and contractile-to-synthetic phenotype transformation by sponging microRNAs (e.g., miR-548f-5p, miR-939, miR-148a-5p, miR-138, miR-351-5p, miR-342-3p). This review describes recent progress in the profiling of circRNAs by transcriptome analysis in VSMCs and their molecular functions in regulating VSMC proliferation and migration.
ducibility and the midterm results of the chimney/snorkel endovascular technique (ch-EVAR) in the treatment of type Ia endoleaks after standard EVAR. Methods: Between January 2008 and December 2014, 517 ch-EVAR abdominal procedures were performed in 13 United States and European vascular centers (PERICLES registry). Of these, 39 (25 men) were treated due to persistent type Ia endoleak after standard EVAR and had at least one radiologic postoperative follow-up with computed tomography angiography (CTA). Results: Mean age of the treated patients was 76.2 6 7.6, and all were classified as American Society of Anesthesiologists III or IV. Mean aneurysm diameter was 71.5 6 29.0 mm. Mean infrarenal neck length was 3.9 mm, requiring lengthening of the sealing zone by placement of chimney grafts. The newly created sealing zone increased to 21.2 mm. Operative variables are summarized in Table I. Endurant abdominal devices were used in 20 patients (51.3%). Single chimney graft placement was performed in 18 patients (46.1%) and multiple in 21 (53.9%). Overall, 70 visceral vessels were revascularized by chimney grafts. Operative outcomes are summarized in Table II. The 30-day mortality was 2.6% (1 cardiac death). Two other deaths occurred during the mean follow-up of 21.9 months due to nonaneurysm-related causes. Primary patency of the chimney grafts was 89.7%. Three type Ia endoleaks were detected. Two of them were treated conservatively by radiologic surveillance, and one, with an additional increase of the aneurysm sac of >5 mm, was treated invasively. No statistically significant difference was noted in from type Ia endoleak at follow-up between ch-EVAR performed by the Endurant device (1 of 20 [5%]) vs other devices (2 of 19 [10.5%]; P ¼ .6) as well in terms of reintervention (1 of 20 [5%] vs 0 of 19 [0%]; P ¼ 1.000), respectively. Conclusions: The present largest series in the literature regarding ch-EVAR in the treatment of type Ia endoleaks after previous EVAR showed reproducible results independent of the abdominal and chimney grafts combinations that were used. Longer follow-up is needed to ensure the durability of the present findings.
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