Endovascular treatment of extracranial carotid artery aneurysms using self-expandable covered stent grafts: A single center retrospective study

Vascular ◽  
2021 ◽  
pp. 170853812199012
Author(s):  
Peixian Gao ◽  
Jiaxin Qi ◽  
Mo Wang ◽  
Gang Li ◽  
Le Yang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Stent Graft ◽  
Common Carotid Artery ◽  
Covered Stent ◽  
Imaging Features ◽  
Stent Grafts ◽  
Extracranial Carotid Artery ◽  
Covered Stent Graft

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.

scholarly journals Telescoping Dual Covered Stent Graft Construct for Endovascular Treatment of a Giant Extracranial Carotid Artery Pseudoaneurysm

2016 ◽  
Vol 07 (S 01) ◽  
pp. S103-S105
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
Maurice Moriarty ◽  
Stefan Brew
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Stent Graft ◽  
Covered Stent ◽  
Parent Artery ◽  
Artery Pseudoaneurysm ◽  
Extracranial Carotid Artery ◽  
Luminal Narrowing ◽  
Proximal Internal Carotid Artery ◽  
Covered Stent Graft

ABSTRACTLarge pseudoaneurysms which compress the parent vessel are challenging lesions to successfully treat with endovascular therapy. We describe the endovascular treatment of a giant extracranial carotid artery (ECCA) pseudoaneurysm resulting in substantial mass effect on the common carotid artery (CCA) bifurcation using a telescoping dual covered stent graft construct. A 56-year-old male was diagnosed with an 8.5 cm × 13 cm pseudoaneurysm arising from the left CCA bifurcation, which was causing luminal narrowing of the CCA and proximal internal carotid artery (ICA). The patient underwent endovascular intervention, during which a balloon-expandable covered stent was deployed within a heparin-bonded covered stent, such that the overall construct spanned from the CCA to the lower cervical ICA. The employment of a telescoping dual covered stent technique can successfully treat appropriately selected patients with large or giant ECCA pseudoaneurysms, with the concomitant goals of excluding the pseudoaneurysm and restoring the luminal caliber of the parent artery.

Ruptured extracranial carotid artery: Endovascular treatment with covered stent graft

2018 ◽  
Vol 45 (4) ◽  
pp. 217-223 ◽  
Author(s):  
Ho Cheol Choi ◽  
Sung Eun Park ◽  
Dae Seob Choi ◽  
Hwa Seon Shin ◽  
Ji Eun Kim ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Stent Graft ◽  
Covered Stent ◽  
Extracranial Carotid Artery ◽  
Covered Stent Graft

Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms

2009 ◽  
Vol 110 (3) ◽  
pp. 418-426 ◽  
Author(s):  
Min He ◽  
Heng Zhang ◽  
Ding Lei ◽  
Bo-Yong Mao ◽  
Chao You ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Graft ◽  
Posterior Inferior Cerebellar Artery ◽  
Covered Stent ◽  
Stent Grafts ◽  
Graft Placement ◽  
Cerebellar Artery ◽  
Covered Stent Graft ◽  
Dissecting Aneurysms

Object Utilization of covered stent grafts in treating neurovascular disorders has been reported, but their efficacy and safety in vertebral artery (VA) dissecting aneurysms needs further investigation. Methods Six cases are presented involving VA dissecting aneurysms that were treated by positioning a covered stent graft. Two aneurysms were located distal to the posterior inferior cerebellar artery, and 4 were located proximal to the posterior inferior cerebellar artery. Aspirin as well as ticlopidine or clopidogrel were administered after the procedure to prevent stent-related thrombosis. All patients were followed up both angiographically and clinically. Results Five of the 6 patients underwent successful placement of a covered stent graft. The covered stent could not reach the level of the aneurysm in 1 patient with serious vasospasm who died secondary to severe subarachnoid hemorrhage that occurred 3 days later. Patient follow-up ranged from 6 to 14 months (mean 10.4 months), and demonstrated complete stabilization of the obliterated aneurysms, and no obvious intimal hyperplasia. No procedure-related complications such as stenosis or embolization occurred in the 5 patients with successful stent graft placement. Conclusions Although long-term follow-up studies using a greater number of patients is required for further validation of this technique, this preliminary assessment shows that covered stent graft placement is an efficient, safe, and microinvasive technique, and is a promising tool in treating intracranial VA dissecting aneurysms.

Application of covered stent graft in the treatment of complex carotid artery lesions: A single center experience

Vascular ◽  
2021 ◽  
pp. 170853812110409
Author(s):  
Changya Liu ◽  
Yin Shen ◽  
Kang Qian ◽  
Yueyun Hu ◽  
Xuebin Hu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Perioperative Complications ◽  
Stent Migration ◽  
Covered Stent ◽  
Parent Artery ◽  
Imaging Features ◽  
Stent Grafts ◽  
Single Center Experience ◽  
Carotid Artery Lesions

Purpose To assess the clinical efficiency and imaging outcome of applying covered stent grafts for the treatment of complex carotid artery lesions. Method A total of 39 consecutive patients with carotid artery lesions treated with covered stent grafts at our institution from December 2016 to December 2019 were reviewed. Two kinds of stent including self-expandable covered stent (Viabahn; W. L. Gore & Associates) and balloon-expandable covered stent (Willis; Microport) were applied. The angiograms immediately after the procedure, perioperative complications, and follow-up outcomes were recorded. Result Based on imaging features, 11 patients exhibited pseudoaneurysms, 23 patients had blood blister-like aneurysms (BBAs), and five patients were carotid cavernous fistulas. A total of 40 stent implantations were performed, including nine Viabahn stents and 31 Willis stents. Two patients received double implants of Willis stents. Stent failed to perform for one patient due to tortuous parent artery. The angiography reports immediately after the procedure showed that the lesions in 36 patients were completely occluded, whereas two patients had minimal endoleaks. With respect to the occurrence of procedural complications, an aneurysm ruptured during the procedure in one case, which resulted in CCF, and acute in-stent thrombosis occurred in another case. Clinical and angiographic follow-up (11.2±2.4 months) sessions were conducted for 38 patients and a complete lesion exclusion was achieved in 36 patients. The minimal endoleak persisted in one patient and another patient experienced recurrence with stent migration, leading to ipsilateral blepharoptosis. However, none of the patients developed hemorrhage or ischemia and in-stent stenosis was not observed. Conclusion Covered stent grafts appear to be a safe and feasible for the treatment of complex carotid artery lesions. Despite the potential for stent delivery failure as well as endoleak and procedure-related complications, covered stent grafts should be considered when selecting the optimal treatment strategy.

scholarly journals Treatment of an Acute Mycotic Aneurysm of the Common Carotid Artery with a Covered Stent-Graft

2012 ◽  
Vol 53 (1) ◽  
pp. 224 ◽  
Author(s):  
Suk Hoon Lee ◽  
Young Kwon Cho ◽  
Jong Moo Park ◽  
Curie Chung ◽  
Hyun Suk Kim ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Graft ◽  
Common Carotid Artery ◽  
Mycotic Aneurysm ◽  
Covered Stent ◽  
The Common ◽  
Covered Stent Graft

Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110232
Author(s):  
Peixian Gao ◽  
Changliang Li ◽  
Xuejun Wu ◽  
Gang Li ◽  
Dianning Dong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Occlusive Disease ◽  
Metal Stents ◽  
Infrarenal Aorta ◽  
Bare Metal ◽  
Stent Grafts ◽  
Aortoiliac Occlusive Disease

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

scholarly journals Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts

2020 ◽  
Vol 44 (12) ◽  
pp. 4267-4274
Author(s):  
Felice Pecoraro ◽  
Ettore Dinoto ◽  
Domenico Mirabella ◽  
Francesca Ferlito ◽  
Arduino Farina ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Graft ◽  
Abdominal Aorta ◽  
Infrarenal Aorta ◽  
Acute Aortic Syndrome ◽  
Technical Success ◽  
Stent Grafts ◽  
Femoral Access ◽  
Persistent Symptoms

Abstract Introduction Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS. Methods From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms and/or dilated abdominal aorta (>3 cm). The measured outcomes were technical success; early outcomes (<30 days) including mortality, morbidity, symptoms recurrence, and endoleak occurrence; and late outcomes (>30 days) including mortality, symptoms recurrence, endoleak occurrence, stent-graft patency, and survival. Median follow-up was 23.77 ± 10 months. Results Twenty-one patients with IAAS were included. Indications to treatment were symptoms in 14 (67%) patients and dilated abdominal aorta in 7 (33%). Technical success was achieved in all cases. No perioperative mortality and 1 (4.8%) early femoral access complication was encountered. During the follow-up were registered 1 (4.8%) aortic unrelated death and 1 (4.8%) stent-graft limb stenosis. The 36 months estimated survival and freedom from reintervention were 92% (CI: 37–43; SE: 1.7) and 94% (CI: 37–44; SE: 1.7), respectively. Conclusions The endovascular treatment of IAAS with unibody stent-graft (AFX endovascular AAA system; Endologix Inc.) is safe and effective with promising mid-term outcomes. The use of unibody stent-grafts expands the endovascular indication, despite the usual anatomic IAAS features. Larger studies with longer follow-up are required to validate the outcomes of the reported technique.

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