Endovascular implantation of covered stents in the extracranial carotid and vertebral arteries: Case series and review of the literature

Abstract

Background:Covered stents are used endovascularly to seal arterial wall defects while preserving vessel patency. This report describes our experience with the use of covered stents to treat cervical pathology, and a review of the literature in regards to this topic is presented.Case Description:Two patients presenting with the carotid blowout syndrome and one patient with a vertebrojugular fistula were treated with covered stents. This allowed for preservation of the vessel and was a treatment alternative to cerebral bypass.Conclusion:Covered stents provide a viable means of preserving the cervical vessels in selected patients; however, long-term follow-up is necessary to determine stent patency and permanency of hemostasis.

Successful Endovascular Treatment with Covered Stent for Iatrogenic Vertebral Arteriovenous Fistula

“…In our patient, because the concomitant use of an anticoagulant was necessary, we prescribed monoantiplatelet therapy; however, Alaraj et al adopted 6 month DAPT combined with lifetime monoantiplatelet therapy based on reported evidence for carotid artery stenting. 15) Gaynor et al also reported no ischemic complications in any of their 15 patients with carotid blowout syndrome treated using a covered stent (Viabahn). 27) Given that all patients in the report were administered two antiplatelet drugs for at least 6 weeks, DAPT may be an important factor in preventing covered stent occlusion.…”

“…Additional treatment is reported to be unnecessary for endoleaks for at least 1 month with lifetime monoantiplatelet therapy. The review of Alaraj et al 15) included a large number of patients and showed a high long-term patency rate after treatment with a covered stent; therefore, long-term DAPT, or at least one antiplatelet agent if an anticoagulant is used, is considered necessary. In our patient, because the concomitant use of an anticoagulant was necessary, we prescribed monoantiplatelet therapy; however, Alaraj et al adopted 6 month DAPT combined with lifetime monoantiplatelet therapy based on reported evidence for carotid artery stenting.…”

“…The prevalence of complications over the longterm following endovascular treatment using a covered stent in the extracranial carotid artery/vertebral artery region is reportedly 9.1% (15/164 cases), and complications included ischemic stroke in 1.2% (two cases), transient ischemic attack in 3.6% (six cases), and acute arterial dissection in 1.8% (three cases) of patients. 15) Regarding the patency rate, restenosis was observed in 2.8% (three cases), and stent occlusion was observed in 8.3% (nine cases) of the 97 cases followed-up by cerebral angiography (median follow-up period: 6 months [range, 4-17.8 months]). 15) This patency rate, calculated by including all cases of covered stent placement in the extracranial carotid and vertebral artery, is higher than the patency rate for typical stents.…”

“…When disease is limited to VAVF, there have been 13 reports including 15 patients undergoing endovascular treatment, according to our review ( Table 2). 11,[15][16][17][18][19][20][21][22][23][24][25][26] Complete occlusion was achieved immediately after the procedure or at the final follow-up in 14 patients, and the procedure is considered useful in the short term. The prevalence of complications over the longterm following endovascular treatment using a covered stent in the extracranial carotid artery/vertebral artery region is reportedly 9.1% (15/164 cases), and complications included ischemic stroke in 1.2% (two cases), transient ischemic attack in 3.6% (six cases), and acute arterial dissection in 1.8% (three cases) of patients.…”

“…15) By the disease, they consisted of 81 cases of pseudoaneurysm, 27 cases of carotid blowout syndrome, 23 cases of arteriovenous fistula, and 19 others. The success rate for endovascular treatment was high at 98.2% and additional treatment was performed in only one patient who developed endoleak, indicating the usefulness of the treatment.…”