Application of the Willis Covered Stent in the Treatment of Complex Vascular Diseases of the Internal Carotid Artery and Vertebral Artery: A Retrospective Single-Center Experience

Abstract

Objective To retrospectively evaluate the efficacy and security of Willis covered stent (WCS) deployment for complex vascular diseases of the internal carotid (ICA) and vertebral (VA) arteries. Methods Retrospective analysis was performed on complex vascular disease patients (n=36) treated with WCSs at our center between March 2017 and December 2022, with a 3–36-months follow-up surveillance and digital subtraction angiography (DSA) examination. Results The WCSs were successfully deployed in all the patients. The 36 included lesions were carotid-cavernous sinus fistulas (CCFs; n=10) (27.8%), complex saccular aneurysms (n=10) (27.8%), traumatic pseudoaneurysms (n=7) (19.4%), blood blister-like aneurysms (BBAs; n=5) (13.9%), and iatrogenic carotid or vertebral artery ruptures (n=4) (11.1%). The WCS was released at the communicating segment (n=2) (5.6%), the ophthalmic segment (n=3) (8.3%), the clinoid and cavernous segment (n=28) (77.8%), the petrous segment (n=2) (5.6%) of ICA and the V3 segment (n=1) (2.8%) of VA. Postoperative DSA showed complete lesion occlusion in 26 patients (72.2%) who were immediately treated with WCSs, and endoleaks occurred in 3 patients (8.3%) (endoleaks resolved postadjustment in 7 patients (19.4%)). In patients (n=3) (8.3%) treated with double stents at the break of the ICA, the endoleak remained in 1 CCF patient (2.8%) during the 3-month follow-up, and the residual shunt disappeared after the second stent system was placed 3 months later. No aneurysm, bleeding or infarct recurrence reported, and only 1 patient (2.8%) had mild asymptomatic in-stent stenosis. Deaths and procedural complications did not occur during follow-up. Conclusion Treatment with a WCS for intracranial complex vascular diseases resulted in satisfactory clinical outcomes and appeared effective and safe. Controlled, multicenter, large sample sizes and longer follow-up periods studies are necessary.

Endovascular Treatment of Traumatic Vascular Injuries in the Head and Neck Region

“…One of the key findings of our study was the successful use of covered stents in managing carotid artery injuries: five out of the six patients with CCA or ICA injuries were successfully treated with covered stents alone. This finding is supported by other research, which advocates the use of covered stents for their ability to seal arterial disruptions while preserving blood flow, thereby reducing the risk of stroke and other complications [9][10][11][12][13][14][15]. In one patient with CCF, balloon-assisted coil embolization was attempted but failed, and the ICA was sacrificed with multiple coils.…”

“…In our study, antiplatelet and anticoagulation therapy was used only when complete hemostasis was determined angiographically and clinically, and not otherwise. Most of the other trials used dual antiplatelet therapy with clopidogrel and aspirin [14,[16][17][18]. One study used systemic anticoagulation therapy with heparin as in our study, but there were no cases of rebleeding or hemorrhagic complications associated with triple antithrombotic therapy [22].…”