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

2012 ◽  
Vol 34 (6) ◽  
pp. 523-529 ◽  
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

Reconstructive endovascular treatment of ruptured blood blister–like aneurysms of the internal carotid artery

2009 ◽  
Vol 110 (3) ◽  
pp. 431-436 ◽  
Author(s):  
Byung-Hee Lee ◽  
Byung Moon Kim ◽  
Moon Sun Park ◽  
Sung Il Park ◽  
Eun Chul Chung ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Scale Score ◽  
Stent Placement ◽  
Glasgow Outcome Scale ◽  
Internal Carotid ◽  
Covered Stent ◽  
Stent Insertion ◽  
Endovascular Methods

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.

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.

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.

Hybrid Repair of a Common Carotid Pseudoaneurysm and Concomitant Internal Carotid Stenosis With Retrograde Stenting and Carotid Endarterectomy

2021 ◽  
pp. 153857442199293
Author(s):  
Constantinos Zarmakoupis ◽  
George Galyfos ◽  
Grigorios Tsoukalos ◽  
Panagiota Dalla ◽  
Alexandra Triantafyllou ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Covered Stent ◽  
Hybrid Technique ◽  
Hybrid Repair ◽  
Ica Stenosis

This report aims to present a rare case of a common carotid artery (CCA) pseudoaneurysm with a concomitant internal carotid artery (ICA) stenosis that were treated with a hybrid technique. This strategy included the retrograde placement of a CCA covered stent under ICA clamping followed by standardized carotid endarterectomy. The technique will be discussed and compared with other possible treatments.

scholarly journals Indications and Problems of Intracranial Stenting Report of Two Cases

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 149-154
Author(s):  
J. Deguchi ◽  
T. Kuroiwa ◽  
S. Nagasawa ◽  
G. Satoh ◽  
T. Ohta
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
External Force ◽  
Stent Placement ◽  
Internal Carotid ◽  
Total Occlusion ◽  
Intracranial Stenting ◽  
Linear Portion ◽  
Vertebrobasilar Artery ◽  
Intracranial Arteries

There have been few reports of stenting in the intracranial arteries. We used coronary stents in the chronically occluded intracranial vertebral artery and stenosis of internal carotid artery by the external force, and good blood flow were resumed. Stenosis in the intracranial arteries is also a good indication for stent placement when it is due to chronic total occlusion or artery compression by external force. But stent placement in the intracranial arteries has some problems. Stent placement in the intracranial artery is indicated only when the site of stent placement has a diameter of 3 mm or more, is a relatively linear portion of the vertebrobasilar artery or the internal carotid artery proximal to the C3 segment, and does not branch off perforating arteries or is already completely occluded.

Abstract TP467: Effects of the Tortuosity of the Cervical Internal Carotid Artery on Procedural Outcomes of Stent Placement

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Iqra N Akhtar ◽  
Raza S Hyder ◽  
Vamshi Balasetti ◽  
Nitish Kumar ◽  
Jacqueline J Kraus ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Consecutive Series ◽  
Complication Rates ◽  
Grade 5 ◽  
Vessel Tortuosity ◽  
Grade 3 ◽  
Cervical Internal Carotid Artery

Introduction: Severe tortuosity of the cervical internal carotid artery distal to the stenosis may prevent successful placement of distal protection device and increase the risk of dissection and/or ischemic stroke. Objective: To assess and categorize the effects of tortuosity of the cervical internal carotid artery distal on procedural times, and peri-procedural complications in patients treated with carotid artery stent placement. Material and Methods: We analyzed the angiographic images and clinical data for a consecutive series of patients treated with stent placement over an 18-month period and graded the tortuosity as follows: Grade 0 is no vessel turns; Grade 1 (MILD) is 1 vessel turn, >90 degrees; Grade 2 (MODERATE) is 1 vessel turn, ≤90 degrees; Grade 3 (SEVERE) is 2 vessel turns, any angle; Grade 4 (SEVERE) is two vessel segments which are parallel to due to interspersed loop; Grade 5 (SEVERE) is a complete vessel loop (360 degrees). Technical complications including unsuccessful attempts to cross the stenosis with interventional devices, unutilized distal embolic protection, iatrogenic dissection, and ischemic events were ascertained. Results: A total of 80 patients were identified who underwent stent placement; mean (SD) 67.4 (8), 60 (75%) were men. Forty-three patients (53.8%) had evidence of stroke on non-invasive imaging prior to stent placement. In sixty-five cases, stent placement was performed electively (81.3%), emergently in fifteen cases (18.8%). The tortuosity was graded as 1 (46.2%), 2 (11.3%), 3 (15%), 4 (6.3%), and 5 (2.5%). Of the 80 patients, eighteen (22.5%) had severe tortuosity of grade 3 or higher. Mean procedural time (SD) was significantly greater with severe vessel tortuosity compared to mild to moderate vessel tortuosity (51.6 (6.2) versus 42.3 (5.2) minutes, p=.042). Technical complication rates were not significantly different with severe vessel tortuosity compared with mild to moderate vessel tortuosity (7% vs 9% p=.53). One intra-procedural dissection occurred in a case of severe tortuosity (grade 5). Conclusions: Severely tortuous internal carotid arteries distal to the stenosis can be seen in one fifth of patients undergoing carotid stent placement and is associated with increased procedural times.

Patient presentation, angiographic features, and treatment of strangulation-induced dissection of the internal carotid artery

2000 ◽  
Vol 92 (3) ◽  
pp. 481-487 ◽  
Author(s):  
Adel M. Malek ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Constantine C. Phatouros ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Artery Dissection ◽  
Percutaneous Angioplasty ◽  
Consistent Finding ◽  
Content Type ◽  
Fine Print

✓ Domestic violence leading to strangulation by an abusive spouse can cause carotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strategies in three additional cases.Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of the patients suffered delayed cerebral infarctions before presentation and angiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplasia. One of these patients underwent unilateral percutaneous angioplasty with stent placement, and the other underwent bilateral percutaneous angioplasty. Both patients have recovered from their strokes and remain clinically stable at 8 and 20 months posttreatment, respectively. The third patient presented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent of the established infarctions, this case was managed with a long-term regimen of anticoagulation medications, and the patient remains neurologically impaired.These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in which percutaneous angioplasty and/or stent placement are used can be useful in treating residual focal stenoses to improve cerebral perfusion and to lower the risk of embolic or ischemic stroke.

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