Abstract:Implantation of self-expandable stents in treatment of selected extracranial ICAD cases is safe. This method may enable us to restore immediately and usually permanently proper arterial blood flow in the ICA and in consequence lead to significant clinical improvement in the late follow-up period.
“…The optimal treatment strategy is still on debate mainly because of small numbers of experiences and lack of guidelines. 1–3,5,8–12 Conservative management comprising of anticoagulation or antiplatelet medication might be justified in lower risks of cerebral stroke in asymptomatic patients, but seems ineffective in relieving symptom burden, and the risks of thrombus formation and cerebrovascular accidents still remain. 2,9,13 Surgical exclusion of aneurysm with restoration of blood flow has been regarded as the primary strategy in symptomatic or growing ECAAs.…”
Objectives This study was aimed to evaluate the safety and efficacy of endovascular treatment of extracranial carotid artery aneurysms (ECAAs) using self-expandable covered stent grafts. Methods All patients with ECAA at a single institution were reviewed from February 2014 to February 2020. Eight consecutive patients (three men, mean age 64.5 years) treated with endovascular repair with self-expandable covered stent graft were retrospectively reviewed. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. Access to ECAA was gained via a femoral approach or a direct puncture of common carotid artery after surgical exposure because of kinking of the aortic arch and common carotid artery. A self-expandable covered stent graft (Viabahn; W. L. Gore, Flagstaff, AZ) was deployed to exclude the aneurysm. Results Based on imaging features, there were five peudoaneurysms and three true aneurysms. The technical success rate was 100%. Cerebral protection devices were not used in all the patients during the procedures. Immediate absolute obliteration of the ECAA with no endoleak was documented in all the patients. Perioperative complications included one internal carotid-cavernous sinus fistula, one bleeding at the puncture site, and one stroke. The mean follow-up period was 35.5 months (range, 9–72 months). All the patients were alive, with an obligation rate of 100%. No transient ischemia attack, stroke, or reoccurrence of symptoms was identified during the follow-up period. Radiological examinations identified patency of the stent grafts and revealed no endoleaks, stent fracture, stent migration, or aneurysm rupture. Conclusions Endovascular treatment of ECAAs with self-expandable covered stent grafts appears to be a safe and feasible alternative for traditional open surgery, especially in the challenging anatomy and instable physical conditions. Although cerebrovascular accidents can occur as the result of hemodynamic changes during the perioperative period, the minimal alternative can yield satisfactory midterm follow-up clinical outcomes.
“…The optimal treatment strategy is still on debate mainly because of small numbers of experiences and lack of guidelines. 1–3,5,8–12 Conservative management comprising of anticoagulation or antiplatelet medication might be justified in lower risks of cerebral stroke in asymptomatic patients, but seems ineffective in relieving symptom burden, and the risks of thrombus formation and cerebrovascular accidents still remain. 2,9,13 Surgical exclusion of aneurysm with restoration of blood flow has been regarded as the primary strategy in symptomatic or growing ECAAs.…”
Objectives This study was aimed to evaluate the safety and efficacy of endovascular treatment of extracranial carotid artery aneurysms (ECAAs) using self-expandable covered stent grafts. Methods All patients with ECAA at a single institution were reviewed from February 2014 to February 2020. Eight consecutive patients (three men, mean age 64.5 years) treated with endovascular repair with self-expandable covered stent graft were retrospectively reviewed. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. Access to ECAA was gained via a femoral approach or a direct puncture of common carotid artery after surgical exposure because of kinking of the aortic arch and common carotid artery. A self-expandable covered stent graft (Viabahn; W. L. Gore, Flagstaff, AZ) was deployed to exclude the aneurysm. Results Based on imaging features, there were five peudoaneurysms and three true aneurysms. The technical success rate was 100%. Cerebral protection devices were not used in all the patients during the procedures. Immediate absolute obliteration of the ECAA with no endoleak was documented in all the patients. Perioperative complications included one internal carotid-cavernous sinus fistula, one bleeding at the puncture site, and one stroke. The mean follow-up period was 35.5 months (range, 9–72 months). All the patients were alive, with an obligation rate of 100%. No transient ischemia attack, stroke, or reoccurrence of symptoms was identified during the follow-up period. Radiological examinations identified patency of the stent grafts and revealed no endoleaks, stent fracture, stent migration, or aneurysm rupture. Conclusions Endovascular treatment of ECAAs with self-expandable covered stent grafts appears to be a safe and feasible alternative for traditional open surgery, especially in the challenging anatomy and instable physical conditions. Although cerebrovascular accidents can occur as the result of hemodynamic changes during the perioperative period, the minimal alternative can yield satisfactory midterm follow-up clinical outcomes.
“…One alternative is the placement of flow diverters or intracranial stents to keep the arterial lumen patent (Figure 1). [7][8][9] In our experience, the use of the Wingspan stent is a good alternative, due to its radial force that keeps the lumen of the artery patent without the need to dilate prior to or following stent placement. Another characteristic is its navigability through the arterial loops, without the need for distal access in small caliber branches.…”
Section: Discussionmentioning
confidence: 99%
“…One alternative is the placement of flow diverters or intracranial stents to keep the arterial lumen patent (Figure 1). 7–9 Figure 1.Dissection in the cervical internal carotid artery, in a loop (a). It is associated with the presence of a thrombus in the M2 branch.…”
Section: Discussionmentioning
confidence: 99%
“…7 One alternative is to use stents designed for intracranial use in areas of elongation and curves of the cervical and petrous carotid. 8–10 The primary problem with the use of intracranial stents is the low radial force that occasionally does not keep the vascular lumen open properly; and if the caliber of the artery is greater than the sizes of the devices used for intracranial treatment.…”
Objective The purpose of this study is to demonstrate our experience in endovascular reconstruction of carotid dissections using the Wingspan Stent System™ (Boston Scientific, Natick, MA, USA), a device we use because of its high radial force and its navigation in extreme curves. Methods We treated 11 consecutive patients with acute ischemic stroke due to carotid dissection with the Wingspan stent, in the cervical carotid artery. Results Functional evaluation revealed that 10 of the 11 patients were independent at 3 months post surgery and that the 11 stents used were found to be patent at the 6-month follow-up digital subtraction angiography (DSA). Conclusions The Wingspan stent is an alternative to classic carotid stents and flow diverters for the treatment of cervical internal carotid artery (ICA) dissection associated with ectasias or large loops. The device remains patent over the long term and it is not associated with arterial wall complications.
“…Emergent endovascular treatment, including carotid revascularization and intracranial thrombectomy, is an increasingly popular and promising management strategy [1, 5-8]. A variety of techniques have been described for carotid revascularization in this setting, including the use of dedicated carotid artery stents with or without balloon angioplasty [2, 9, 10], the use of self-expanding intracranial or peripheral stents [11-13], and the use of an overlapping or telescoping stenting technique [9]. Recently, Murias Quintana et al [3] called attention to the importance of considering ectatic or tortuous ICA anatomy that could impact the choice of carotid revascularization technique.…”
Background: Endovascular treatment options for internal carotid artery (ICA) dissection with tandem intracranial occlusion are evolving. We report 2 cases of stent reconstruction of carotid loop dissections. Methods: Two patients with symptomatic ICA dissections of true 360° tonsillar loops and tandem intracranial occlusions were treated with manual aspiration thrombectomy (MAT) and telescoping Zilver self-expanding peripheral stents. Patient demographics, clinical presentations, endovascular techniques, and clinical outcomes were reviewed. Results: In both cases, MAT achieved modified Treatment in Cerebral Ischemia scale 2B reperfusion, and complete endovascular reconstruction of the dissected extracranial loop was performed. Both patients had improved pre- to postintervention National Institutes of Health Stroke Scale scores (16 to 0 and 14 to 0), and both had modified Rankin scale scores of 1 at 3-month follow-up. Conclusions: Stent reconstruction of complex cerebrovascular anatomy is increasingly feasible with advancements in stent technology and catheter support system design. This technique may be of use to neuroendovascular surgeons who encounter variant ICA anatomy.
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