Endovascular Treatment of Innominate Artery Bifurcation Injury with Balloon-Expandable Covered Stents Utilizing Kissing Stent Technique

2021 ◽  
pp. 000313482110488
Author(s):  
Anthony L. Grzeda ◽  
Marcus D. Moseley ◽  
Daisy Sangroula ◽  
Erik J. Wayne ◽  
Amit J. Dwivedi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Placement ◽  
Open Repair ◽  
Innominate Artery ◽  
Covered Stent ◽  
Attractive Alternative ◽  
Covered Stents ◽  
Major Injury ◽  
Kissing Stent Technique ◽  
Kissing Stent

Major injury of the innominate artery is traditionally treated with an open repair which is technically challenging, associated with large volumes of blood loss and prolonged operative times. Endovascular treatment with covered stent placement across the injury is an attractive alternative. However, placement of a single covered stent across the innominate artery bifurcation into one of its distal branches will not prevent bleeding because of retrograde perfusion from the unstented branch distal to the bifurcation. Here, we report a case of successful endovascular repair of one such injury involving the innominate artery bifurcation with ongoing extravasation into the mediastinum. The injury was successfully treated by utilizing 2 balloon-expandable covered stents placed in kissing fashion from the innominate artery into both of its distal branches. This technique of parallel covered stent placement across a bifurcation could effectively repair bifurcation injuries while maintaining patency of both distal branches.

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

Neurosurgery ◽  
2016 ◽  
Vol 79 (6) ◽  
pp. 794-805 ◽  
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.

scholarly journals Endovascular Treatment of Posttraumatic Pseudoaneurysm of the Common Carotid Artery

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Diego Rojas ◽  
Stefan Stefanov ◽  
Luis Riera del Moral ◽  
Jesús Álvarez ◽  
Luis Riera de Cubas
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Common Carotid Artery ◽  
Innominate Artery ◽  
Covered Stent ◽  
Neurological Dysfunction ◽  
Covered Stents ◽  
Femoral Access ◽  
Carotid Artery Injuries ◽  
The Right

Carotid artery injuries with pseudoaneurysm are uncommon but associated with central neurologic dysfunction. We present a case of posttraumatic pseudoaneurysm of the right common carotid artery treated by implantation of a covered stent. A 44-year-old woman with multiple injuries after fall from height presents a small dissection flap of the right common carotid artery (RCCA) on the initial computed tomography angiography (CTA). Fifteen days later a 10 mm pseudoaneurysm is observed on control CTA. We decided endovascular treatment. Through right femoral access with a long introducer sheath placed in the innominate artery, we implanted a covered stent Advanta V129×38 mm in the RCCA. The patient was discharged from the hospital with antiplatelet therapy without any neurological dysfunction and complete exclusion of the pseudoaneurysm. Use of covered stents has emerged as a safe and effective alternative to surgical repair of carotid injuries.

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

2009 ◽  
Vol 15 (2) ◽  
pp. 191-196 ◽  
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.

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

2015 ◽  
Vol 122 (5) ◽  
pp. 1223-1228 ◽  
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.

Reconstructive endovascular treatment of intracranial aneurysms with the Willis covered stent: medium-term clinical and angiographic follow-up

2011 ◽  
Vol 114 (4) ◽  
pp. 1014-1020 ◽  
Author(s):  
Hua-Qiao Tan ◽  
Ming-Hua Li ◽  
Pei-Lei Zhang ◽  
Yong-Dong Li ◽  
Jian-Bo Wang ◽  
...  
Keyword(s):  
Stent Placement ◽  
Intracranial Aneurysms ◽  
Therapeutic Option ◽  
Covered Stent ◽  
Aneurysm Rupture ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Covered Stents ◽  
Medium Term

Object Placement of covered stents has emerged as a promising therapeutic option for cerebrovascular diseases. However, the medium- and long-term efficacy and safety of covered stents in the treatment of these diseases remain unclear. The purpose of this study was to evaluate the medium-term clinical and angiographic outcomes of covered stent placement for the treatment of intracranial aneurysms. Methods The authors' institutional review board approved the study. Thirty-four patients (13 females and 21 males; mean age 41.9 years) with 38 intracranial aneurysms were treated with the Willis covered stent. Clinical and angiographic follow-up were performed at 3 months, at 6–12 months, and annually thereafter. The initial procedural and follow-up outcomes were collected and analyzed retrospectively. Results Forty-two covered stents were successfully implanted into the target artery in 33 patients with 37 aneurysms, and 1 covered stent navigation failed in 1 patient. A complete aneurysm exclusion was initially achieved in 24 patients with 28 aneurysms, and a minor endoleak occurred in 9 patients with 9 aneurysms. Postoperatively, 2 patients died of complications related to the procedure. Angiographic and clinical follow-up data are available in 30 patients. The angiographic follow-up (17.5 ± 9.4 months [mean ± SD]) exhibited complete occlusion in 28 patients with 31 aneurysms, and incomplete occlusion in 2 aneurysms, with an asymptomatic in-stent stenosis in 3 patients (10%). The clinical follow-up (26.7 ± 13 months [mean ± SD]) demonstrated that 16 patients (53.3%) experienced a full recovery, and 14 patients (46.7%) improved. No aneurysm rupture, thromboembolic events, or neurological deficits resulting from closure of a perforating vessel by covered stent placement occurred. Conclusions Endovascular reconstruction with the Willis covered stent represents a safe, durable, and curative treatment option for selected intracranial aneurysms, yielding an excellent medium-term patency of the parent artery and excellent clinical outcomes.

scholarly journals Efficacy and hepatic complications of three endovascular treatment approaches for delayed postpancreatectomy hemorrhage: evolution over 15 years

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Yu-Chien Chang ◽  
Kao-Lang Liu ◽  
Yu-Cheng Huang ◽  
Po-Ting Chen ◽  
Yu-Wen Tien ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Hepatic Artery ◽  
Recurrence Rate ◽  
Stent Placement ◽  
Mortality Rates ◽  
Covered Stent ◽  
Complication Rates ◽  
Technical Success ◽  
Treatment Approaches ◽  
Postpancreatectomy Hemorrhage

Abstract Background Delayed postpancreatectomy hemorrhage (PPH) is a fatal complication caused by arterial erosion. This study reports a single-center experience of managing delayed PPH with different endovascular treatment approaches. Methods We reviewed the data of patients who had delayed PPH due to hepatic artery or gastroduodenal artery stump perforation and underwent endovascular treatment between 2003 and 2018. We categorized endovascular treatment approaches involving hepatic artery sacrifice, superselective pseudoaneurysm embolization with hepatic artery preservation, and covered stent placement. Technical success rates, hemorrhage recurrence rates, major and minor hepatic complication rates, and 30-day and 1-year mortality rates were assessed. Results A total of 18 patients were reviewed; 11 (61%), 4 (22%), and 3 (17%) delayed PPH cases were managed through hepatic artery sacrifice, superselective pseudoaneurysm embolization, and hepatic artery stenting, respectively. Multidetector computed tomography was performed in 14 (78%) patients. The technical success rate was 100%. The overall hemorrhage recurrence rate was 39%, with superselective pseudoaneurysm embolization having a 100% hemorrhage recurrence rate—much higher than that of hepatic artery sacrifice or stent graft placement. The overall major and minor hepatic complication rates were 56% and 83%, respectively. The overall 30-day and 1-year mortality rates were 11% and 25%, respectively. The 30-day and 1-year mortality rates and minor and major hepatic complication rates were similar in each group. Conclusion Hepatic artery sacrifice is more effective than superselective pseudoaneurysm embolization in the management of delayed PPH. Covered stent placement may be a reasonable alternative treatment to hepatic artery sacrifice.

Endovascular Treatment of Blunt Traumatic Abdominal Aortic Occlusion With Kissing Stent Placement

2011 ◽  
Vol 35 (5) ◽  
pp. 1216-1220 ◽  
Author(s):  
Koji Idoguchi ◽  
Masato Yamaguchi ◽  
Takuya Okada ◽  
Yoshikatsu Nomura ◽  
Kazuro Sugimura ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Placement ◽  
Aortic Occlusion ◽  
Abdominal Aortic ◽  
Kissing Stent

scholarly journals Anatomically Based Approach for Endovascular Treatment of Vertebro-Vertebral Arteriovenous Fistula

2014 ◽  
Vol 20 (6) ◽  
pp. 766-773 ◽  
Author(s):  
Chih-Hua Yeh ◽  
Yao-Liang Chen ◽  
Yi-Ming Wu ◽  
Yu-Chieh Huang ◽  
Ho-Fai Wong
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Covered Stent ◽  
Treatment Modalities ◽  
Covered Stents ◽  
Vertebral Arteriovenous Fistula ◽  
Fistula Recurrence ◽  
Detachable Coils ◽  
Extracranial Vertebral Artery

Vertebro-vertebral arteriovenous fistula (VV-AVF) is a rare vascular disorder with an abnormal high-flow shunt between the extracranial vertebral artery (VA), its muscular or radicular branches and an adjacent vein. To date, there are no guidelines on the best treatment for VV-AVF. We present our experience of VV-AVF treatment with covered stents in three patients and detachable coils in two patients. One patient with fistula at the V3 segment had rapid fistula recurrence one week after covered stent treatment. The possible causes of failed treatment in this patient are discussed. The currently available treatment modalities for VV-AVF are also summarized after a literature review. At the end of this article, we propose a new concept of anatomically based approach for endovascular treatment of VV-AVF. Fistula in the V1-2 segments of vertebral artery could be treated safely and effectively by covered stent with the benefit of preserving VA patency. Embolization with variable embolizers should be considered first for fistula in the V3 segment because of the tortuous course and flexibility of the VA in this segment.

scholarly journals Reconstructive endovascular treatment of the V4 segment of a vertebral artery dissecting aneurysm with the Willis covered stent: A retrospective study

2019 ◽  
Vol 25 (5) ◽  
pp. 548-555 ◽  
Author(s):  
Sishi Xiang ◽  
Guilin Li ◽  
Chuan He ◽  
Jian Ren ◽  
Hongqi Zhang
Keyword(s):  
Vertebral Artery ◽  
Covered Stent ◽  
Dissecting Aneurysm ◽  
Definitive Treatment ◽  
Attractive Alternative ◽  
Covered Stents ◽  
Technical Success Rate ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Dissecting Aneurysms

Objective Preliminary studies suggest that Willis covered stents may be suitable for the treatment of aneurysms of the internal carotid artery (ICA), but their efficacy and safety in vertebral artery (VA) dissecting aneurysms need further investigation. Methods Consecutive patients who underwent placement of a Willis covered stent for treatment of an aneurysm of the V4 segment of the VA between September 2015 and December 2017 at our institution were retrospectively reviewed. The efficacy, complications, angiographic and clinical follow-up results were collected and analyzed. Results Sixteen covered stents were successfully implanted into the VA in 12 patients with 12 dissecting aneurysms. The technical success rate of stenting placement was 100%. Complete occlusion was achieved in 11 patients immediately after stent placement, with transient endoleak in one aneurysm. Angiographic follow-up (9.9 ± 4.0 months, mean±SD) was performed in nine patients and demonstrated complete stabilization of the obliterated aneurysm. Clinical follow-up (20.1 ± 9.6 months, mean±SD) demonstrated full recovery in 11 patients, and one patient suffered from acute myocardial infarction. Conclusion Reconstruction using a Willis covered stent is an efficient, safe and attractive alternative for the definitive treatment of intracranial VA dissecting aneurysms; longer follow-up and expanded clinical trials are needed for further validation of this technique.

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