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Endovascular stenting for extracranial carotid artery aneurysms

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to investigate the safety and effectiveness of endovascular stenting for extracranial carotid artery aneurysms (ECAAs) and evaluate the mid-term outcomes.

Twelve consecutive symptomatic patients (mean age 43.8 ± 14.9 years; 8 men) with ECAAs who were treated with endovascular stenting between 1997 and 2015 were retrospectively analyzed. Clinical follow-up data including symptoms and neurological events were obtained from outpatient records. Imaging follow-up with duplex ultrasound and/or computed tomographic angiography (CTA) was performed to examine the aneurysm obliteration and patency of the stents at 3, 6, 12 months and yearly thereafter.

A total of 5 true aneurysms and 7 pseudoaneurysms were included in our series. Neurological symptoms (n = 5, 41.7%) and a pulsatile neck mass (n = 5, 41.7%) were the most common presenting symptoms. Endovascular stenting procedures were technically successful in all cases; 3 patients received bare stents, and 9 patients received covered stents. No perioperative neurologic or cardiopulmonary complications occurred. Over a period of follow-ups (mean 21.8 ± 25.1 months), all patients were alive and free from neurological or other adverse events. All aneurysms were completely excluded except for 1 patient who was exposed to a residual medium leaking into the aneurysm sac. No reintervention was performed in this specific patient because aneurysm growth or significant clinical symptoms did not occur. Recurrent restenosis assessed by CTA imaging at 12 months occurred in 1 (8.3%) patient in our series. Target lesion revascularization for this hemodynamic restenosis was treated with placement of an additional stent.

In our series, endovascular stenting for ECAAs was found to be safe, effective, and proved to have promising mid-term results. Although long-term results need to be further explored, advantages including less procedure-related complications and a shorter recovery time make endovascular stenting an attractive option for ECAAs, especially for the patients who are unfit for traditional open surgery.

No MeSH data available.


Related in: MedlinePlus

A 24-year-old male presented with a pulsatile mass on his left neck. Preoperative CTA indicated a true aneurysm in the left internal carotid artery (ICA) near the skull base, which is classified as Attigah type II (A). A guide catheter was placed in the ostium of the common carotid artery (CCA). After angiography was carried out through a guide catheter (B), an 8 × 100 mm covered stent (Viabahn, W.L. Gore) was deployed in the segment of the lesion. Immediate angiography showed absolute obliteration of the aneurysm sac with no endoleak (C). Follow-up CTA imaging results at 12 months showed stent patency without restenosis or endoleak (D). CCA = common carotid artery, CTA = computed tomographic angiography, ICA = internal carotid artery.
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Figure 1: A 24-year-old male presented with a pulsatile mass on his left neck. Preoperative CTA indicated a true aneurysm in the left internal carotid artery (ICA) near the skull base, which is classified as Attigah type II (A). A guide catheter was placed in the ostium of the common carotid artery (CCA). After angiography was carried out through a guide catheter (B), an 8 × 100 mm covered stent (Viabahn, W.L. Gore) was deployed in the segment of the lesion. Immediate angiography showed absolute obliteration of the aneurysm sac with no endoleak (C). Follow-up CTA imaging results at 12 months showed stent patency without restenosis or endoleak (D). CCA = common carotid artery, CTA = computed tomographic angiography, ICA = internal carotid artery.

Mentions: Endovascular procedures were performed on 11 patients under local anesthesia with continuous hemodynamic monitoring according to the standard hospital protocol for carotid artery stenting procedures. Only 1 patient (Patient No. 9) had the procedure performed under general anesthesia. The internal carotid artery (ICA) access was obtained in these 11 patients through the femoral artery approach. After femoral artery access was obtained, heparin was administered according to the standard protocol (100 U/kg). A guide catheter through the support of a 0.035-inch stiff guidewire was placed in the ostium of the common carotid artery (CCA) with fluoroscopic visualization and applicable roadmap guidance if necessary. After carefully maneuvering the soft guidewire past the lesion, a covered stent or self-expanding bare stent was delivered to a proper position under the guidance of roadmap. The diameter of stent could be the same as or bigger than that of the normal artery but no more than 1 mm. Nondiseased carotid artery with a length of ∼1 cm just proximal and distal to the aneurysm was used for the landing zones of stent grafts. After the stents were deployed to cover the aneurysm, multiple control angiographies were obtained to confirm the exclusion of the aneurysm sac from the circulation. If apparent endoleak was present in the aneurysm sac, postdeployment balloon dilatation was performed in the proximal and distal ends of the graft to better appose it to the vessel wall for the full exclusion of the aneurysm. (Examples of endovascular treatment are shown in Figs. 1 and 2.) According to our experience that the risk of distal embolism is relatively low, so cerebral protection devices were selectively applied to 1 patient (Patient No. 8).


Endovascular stenting for extracranial carotid artery aneurysms
A 24-year-old male presented with a pulsatile mass on his left neck. Preoperative CTA indicated a true aneurysm in the left internal carotid artery (ICA) near the skull base, which is classified as Attigah type II (A). A guide catheter was placed in the ostium of the common carotid artery (CCA). After angiography was carried out through a guide catheter (B), an 8 × 100 mm covered stent (Viabahn, W.L. Gore) was deployed in the segment of the lesion. Immediate angiography showed absolute obliteration of the aneurysm sac with no endoleak (C). Follow-up CTA imaging results at 12 months showed stent patency without restenosis or endoleak (D). CCA = common carotid artery, CTA = computed tomographic angiography, ICA = internal carotid artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120949&req=5

Figure 1: A 24-year-old male presented with a pulsatile mass on his left neck. Preoperative CTA indicated a true aneurysm in the left internal carotid artery (ICA) near the skull base, which is classified as Attigah type II (A). A guide catheter was placed in the ostium of the common carotid artery (CCA). After angiography was carried out through a guide catheter (B), an 8 × 100 mm covered stent (Viabahn, W.L. Gore) was deployed in the segment of the lesion. Immediate angiography showed absolute obliteration of the aneurysm sac with no endoleak (C). Follow-up CTA imaging results at 12 months showed stent patency without restenosis or endoleak (D). CCA = common carotid artery, CTA = computed tomographic angiography, ICA = internal carotid artery.
Mentions: Endovascular procedures were performed on 11 patients under local anesthesia with continuous hemodynamic monitoring according to the standard hospital protocol for carotid artery stenting procedures. Only 1 patient (Patient No. 9) had the procedure performed under general anesthesia. The internal carotid artery (ICA) access was obtained in these 11 patients through the femoral artery approach. After femoral artery access was obtained, heparin was administered according to the standard protocol (100 U/kg). A guide catheter through the support of a 0.035-inch stiff guidewire was placed in the ostium of the common carotid artery (CCA) with fluoroscopic visualization and applicable roadmap guidance if necessary. After carefully maneuvering the soft guidewire past the lesion, a covered stent or self-expanding bare stent was delivered to a proper position under the guidance of roadmap. The diameter of stent could be the same as or bigger than that of the normal artery but no more than 1 mm. Nondiseased carotid artery with a length of ∼1 cm just proximal and distal to the aneurysm was used for the landing zones of stent grafts. After the stents were deployed to cover the aneurysm, multiple control angiographies were obtained to confirm the exclusion of the aneurysm sac from the circulation. If apparent endoleak was present in the aneurysm sac, postdeployment balloon dilatation was performed in the proximal and distal ends of the graft to better appose it to the vessel wall for the full exclusion of the aneurysm. (Examples of endovascular treatment are shown in Figs. 1 and 2.) According to our experience that the risk of distal embolism is relatively low, so cerebral protection devices were selectively applied to 1 patient (Patient No. 8).

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to investigate the safety and effectiveness of endovascular stenting for extracranial carotid artery aneurysms (ECAAs) and evaluate the mid-term outcomes.

Twelve consecutive symptomatic patients (mean age 43.8 ± 14.9 years; 8 men) with ECAAs who were treated with endovascular stenting between 1997 and 2015 were retrospectively analyzed. Clinical follow-up data including symptoms and neurological events were obtained from outpatient records. Imaging follow-up with duplex ultrasound and/or computed tomographic angiography (CTA) was performed to examine the aneurysm obliteration and patency of the stents at 3, 6, 12 months and yearly thereafter.

A total of 5 true aneurysms and 7 pseudoaneurysms were included in our series. Neurological symptoms (n = 5, 41.7%) and a pulsatile neck mass (n = 5, 41.7%) were the most common presenting symptoms. Endovascular stenting procedures were technically successful in all cases; 3 patients received bare stents, and 9 patients received covered stents. No perioperative neurologic or cardiopulmonary complications occurred. Over a period of follow-ups (mean 21.8 ± 25.1 months), all patients were alive and free from neurological or other adverse events. All aneurysms were completely excluded except for 1 patient who was exposed to a residual medium leaking into the aneurysm sac. No reintervention was performed in this specific patient because aneurysm growth or significant clinical symptoms did not occur. Recurrent restenosis assessed by CTA imaging at 12 months occurred in 1 (8.3%) patient in our series. Target lesion revascularization for this hemodynamic restenosis was treated with placement of an additional stent.

In our series, endovascular stenting for ECAAs was found to be safe, effective, and proved to have promising mid-term results. Although long-term results need to be further explored, advantages including less procedure-related complications and a shorter recovery time make endovascular stenting an attractive option for ECAAs, especially for the patients who are unfit for traditional open surgery.

No MeSH data available.


Related in: MedlinePlus