Oncologic surgical resection with intravascular covered stent placement in patients with carotid artery encased by metastatic cancer—Our experience with 5 patients

Object Ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. Methods Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42–57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. Results All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4–26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. Conclusions In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.

Download Full-text

Successful devascularization of carotid body tumors by covered stent placement in the external carotid artery

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(09)79125-0 ◽

2009 ◽

Vol 2009 ◽

pp. 304-306

Author(s):

G.L. Moneta

Keyword(s):

Carotid Artery ◽

Carotid Body ◽

Stent Placement ◽

Covered Stent ◽

External Carotid Artery ◽

External Carotid ◽

Carotid Body Tumors

Download Full-text

Treatment of a Traumatic Carotid-Cavernous Fistula with a Covered Stent: Some Considerations

Interventional Neuroradiology ◽

10.1177/159101990901500209 ◽

2009 ◽

Vol 15 (2) ◽

pp. 191-196 ◽

Cited By ~ 3

Author(s):

F.J.A. Meijer ◽

A.M. Van Der Vliet

Keyword(s):

Carotid Artery ◽

Stent Placement ◽

Covered Stent ◽

Balloon Occlusion ◽

Covered Stents ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Limited Experience ◽

Coil Occlusion ◽

Direct Carotid Cavernous Fistula

This article discusses some considerations concerning covered stent placement in a patient with a traumatic direct carotid-cavernous fistula. Our case supports recent reports in the literature that covered stent placement can be an acceptable alternative when detachable balloon occlusion or coil occlusion of a direct carotid-cavernous fistula fails or cannot be done. Positioning of a covered stent in the internal carotid artery can be technically challenging. No specific covered stents for neurovascular use have been designed or registered. Because of limited experience with covered stent placement in the carotid artery the optimal preventive and therapeutic strategies for thromboembolic complications are not known.

Download Full-text

Combined preoperative onyx embolization and protective internal carotid artery covered stent placement for treatment of glomus vagale tumor: review of literature and illustrative case

Neurological Research ◽

10.1179/1743132812y.0000000036 ◽

2012 ◽

Vol 34 (6) ◽

pp. 523-529 ◽

Cited By ~ 7

Author(s):

Ali Alaraj ◽

Kristen Pytynia ◽

Andrew P Carlson ◽

P Hari Krishna ◽

Fady T Charbel ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Stent Placement ◽

Internal Carotid ◽

Covered Stent ◽

Illustrative Case ◽

Review Of Literature

Download Full-text

Successful devascularization of carotid body tumors by covered stent placement in the external carotid artery

Journal of Vascular Surgery ◽

10.1016/j.jvs.2008.05.031 ◽

2008 ◽

Vol 48 (5) ◽

pp. 1322-1324 ◽

Cited By ~ 33

Author(s):

James M. Scanlon ◽

Jacob J. Lustgarten ◽

Stewart B. Karr ◽

Jules I. Cahan

Keyword(s):

Carotid Artery ◽

Carotid Body ◽

Stent Placement ◽

Covered Stent ◽

External Carotid Artery ◽

External Carotid ◽

Carotid Body Tumors

Download Full-text

Treatment of a Case of Common Carotid Artery Pseudoaneurysm That Developed after Surgery for Hypopharynx Cancer by Covered Stent Placement

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.cr.2016-0138 ◽

2017 ◽

Vol 11 (10) ◽

pp. 528-533

Author(s):

Ryuta Matsuoka ◽

Kenta Fujimoto ◽

Ichiro Nakagawa ◽

Mitsuhisa Nishiguchi ◽

Toshitaka Inui ◽

...

Keyword(s):

Carotid Artery ◽

Stent Placement ◽

Common Carotid Artery ◽

Covered Stent ◽

Artery Pseudoaneurysm ◽

Hypopharynx Cancer

Download Full-text

Jostent covered stent placement for emergency reconstruction of a ruptured internal carotid artery during or after transsphenoidal surgery

Journal of Neurosurgery ◽

10.3171/2014.10.jns14328 ◽

2015 ◽

Vol 122 (5) ◽

pp. 1223-1228 ◽

Cited By ~ 7

Author(s):

Byung Moon Kim ◽

Pyoung Jeon ◽

Dong Joon Kim ◽

Dong Ik Kim ◽

Sang Hyun Suh ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Stent Placement ◽

Transsphenoidal Surgery ◽

Internal Carotid ◽

Covered Stent ◽

Active Bleeding ◽

Covered Stents ◽

Surgical Suture

OBJECT Internal carotid artery (ICA) rupture during transsphenoidal surgery (TSS) is an extremely difficult complication to treat. This study aimed to evaluate the immediate and long-term outcomes of covered stent placement for emergency reconstruction of ruptured ICAs during or after TSS. METHODS Seven patients underwent covered stent placement for emergency reconstruction of a ruptured ICA during or after TSS. The safety and effectiveness of covered stent placement for emergency reconstruction of ruptured ICAs were retrospectively analyzed. RESULTS Pretreatment angiography showed active bleeding in 6 patients (5 intraoperative and 1 postoperative) and a pseudoaneurysm in 1 patient. Of the 6 patients with active bleeding, 5 were treated with a successive operation to control active bleeding. The other patient was treated just after cardiopulmonary resuscitation due to massive nasal bleeding 20 days after revision of TSS. All active bleeding was controlled immediately after covered stent insertion in these 6 patients. One patient showed a gap between the covered stent and ICA wall without active bleeding 30 minutes after glycoprotein IIb/IIIa inhibitor administration due to in-stent thrombosis. The gap was occluded with coil embolization after completion of the temporarily suspended TSS. The seventh patient, whose ICA tear was treated with surgical suture, underwent covered stent placement for a pseudoaneurysm detected on postoperative Day 2. During a mean follow-up period of 46 months (range 12–85 months), all patients had excellent outcomes (modified Rankin Scale score of 0). All the stented ICAs were patent on vascular imaging follow-up at a mean of 34 months (range 12–85 months). CONCLUSIONS Covered stents appear to be a safe and effective option for emergency reconstruction of ruptured ICAs during or after TSS.

Download Full-text

Oncologic surgical resection with intravascular covered stent placement in patients with carotid artery encased by metastatic cancer---Our experience with 5 patients

10.22541/au.161847088.80761095/v1 ◽

2021 ◽

Author(s):

Kai Liu ◽

Haidong Zhang ◽

Huanyu Jiang ◽

Shanchun Gong ◽

Xianjun Lyu ◽

...

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Head And Neck ◽

Stent Placement ◽

Tumor Resection ◽

Covered Stent ◽

Advanced Head ◽

Artery Blood Flow ◽

Complete Tumor Resection ◽

Complete Tumor

Importance: Tumor encasement of the common carotid artery (CCA) and/or the internal carotid artery (ICA) in patients with advanced head and neck tumors represents a significant surgical challenge. At present, there are few reports on the treatment approach that can achieve the maximal oncological resection and reduce the difficulty of operation without affecting the carotid artery blood flow. Objective: To examine whether the combination of oncologic complete tumor resection and intravascular covered stent placement is more advantageous in the management of advanced head and neck cancer. Design, Setting, and Participants: Five patients with advanced head and neck squamous cell carcinoma (AHNSCC) invading one side of the carotid artery were retrospectively enrolled. The contrast-enhanced computed Tomography (CT) and angiography were performed to assess the severity of extrinsic tumor compression to the carotid artery. Covered stent was placed intra-arterially at least 1 cm proximal and distal beyond the area of tumor involvement. The tumor and the involved carotid artery were resected, and pectoralis major flap transfer was utilized for coverage of the great vessels supported with intra-arterial covered stent. Main Outcomes and Measures: Efficacy of oncologic complete tumor resection combined with endovascular stent placement. Results: The post-stenting demonstrated an improvement in the appearance and caliber of the affected carotid artery. Four patients experienced transient bradycardia and hypotension. All five patients underwent R0 resection. Postoperatively, the flap all had rich vascularity and healing. Three patients underwent adjuvant radiotherapy or chemoradiation. With median follow-up 6.5 months, one patient died of multiple organ failures at 6.5 months after surgery; one patient developed tracheal stoma recurrence and treated with salvaged surgery; the three other patients had no disease recurrence in their last follow-ups. Conclusions and Relevance: Surgical resection with intravascular covered stent placement could potentially achieve the maximal oncological resection without compromise carotid artery blood flow in patients with carotid artery encased head and neck cancer.

Download Full-text

Reconstruction of the Internal Carotid Artery After Treatment of Complex Traumatic Direct Carotid-Cavernous Fistulas With the Willis Covered Stent

Neurosurgery ◽

10.1227/neu.0000000000001266 ◽

2016 ◽

Vol 79 (6) ◽

pp. 794-805 ◽

Cited By ~ 13

Author(s):

Wu Wang ◽

Ming-Hua Li ◽

Yong-Dong Li ◽

Bin-Xian Gu ◽

Hai-Tao Lu

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Endovascular Treatment ◽

Stent Placement ◽

Internal Carotid ◽

Covered Stent ◽

Covered Stents ◽

Complete Exclusion ◽

Carotid Cavernous Fistulas

Abstract BACKGROUND: Endovascular treatment of complex traumatic direct carotid-cavernous fistulas (TDCCFs) is a challenge. OBJECTIVE: To evaluate the long-term efficacy of the Willis covered stent in endovascular treatment of complex TDCCFs, focusing on reconstruction and preservation of the internal carotid artery. METHODS: During the past 8 years, 25 patients with 27 TDCCFs who previously had unsuccessful treatment of fistulas with detachable balloons received endovascular treatment with Willis covered stents. The efficacy, complications, in-stent stenosis, angiographic, and clinical follow-up results were evaluated retrospectively between 6 and 88 months (mean, 43.8 months) after the stent placement. RESULTS: The technical success rate of stenting placement was 100%. Forty-four Willis covered stents were implanted into the target artery of 27 TDCCFs. Complete exclusion was achieved in 16 patients with 17 TDCCFs immediately after the stent placement, with transient endoleaks in 10 TDCCFs. Redilation was performed in 6 TDCCFs, and additional stents were implanted in the other 4 TDCCFs for endoleak exclusion. The initial angiographic results showed complete exclusion of fistulas with preservation of the internal carotid artery in 24 patients with 26 TDCCFs. One patient in whom complete occlusion initially was achieved subsequently experienced a delayed endoleak, which required placement of an additional stent. The angiographic follow-up results (mean, 30.3 months) demonstrated complete exclusion in all 27 TDCCFs, with patency of internal carotid artery in 23 patients. The clinical follow-up demonstrated a full recovery in 23 patients and improvement in 2 patients. CONCLUSION: The use of Willis covered stents was confirmed to be effective, safe, and a curative approach for endovascular treatment of complex TDCCFs and internal carotid artery reconstruction.

Download Full-text

A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery–cavernous sinus fistula

Journal of Neurosurgery ◽

10.3171/jns/2008/108/3/0588 ◽

2008 ◽

Vol 108 (3) ◽

pp. 588-590 ◽

Cited By ~ 25

Author(s):

Xian-Li Lv ◽

You-Xiang Li ◽

Ai-Hua Liu ◽

Ming Lv ◽

Peng Jiang ◽

...

Keyword(s):

Carotid Artery ◽

Arteriovenous Fistula ◽

Head Trauma ◽

Cavernous Sinus ◽

Stent Placement ◽

Dural Arteriovenous Fistula ◽

Covered Stent ◽

Caroticocavernous Fistula

✓The authors present the case of a patient with a direct carotid artery–cavernous sinus fistula caused by head trauma in whom a self-expanding covered stent was successfully used to obliterate the fistula. However, at the 9-month follow-up an angiogram revealed a complex caroticocavernous fistula that was completely obliterated with Onyx 18 transarterially.

Download Full-text