Limits...
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 45-year-old male suffered from a minor stroke before being diagnosed with a dissecting aneurysm in a high location of the left ICA through CTA examination (A). Endovascular treatment was carried out with deployment of a 6 × 50 mm covered stent (Viabahn, W.L. Gore)(B). Follow-up CTA imaging at 12 months indicated that the level of in-stent restenosis was >70% (marked by white arrows in C). After angiographic assessment (D), an additional stent was placed in the segment of the restenotic lesion after balloon angioplasty with a cerebral protection device in place (E). CTA = computed tomographic angiography, ICA = internal carotid artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5120949&req=5

Figure 3: A 45-year-old male suffered from a minor stroke before being diagnosed with a dissecting aneurysm in a high location of the left ICA through CTA examination (A). Endovascular treatment was carried out with deployment of a 6 × 50 mm covered stent (Viabahn, W.L. Gore)(B). Follow-up CTA imaging at 12 months indicated that the level of in-stent restenosis was >70% (marked by white arrows in C). After angiographic assessment (D), an additional stent was placed in the segment of the restenotic lesion after balloon angioplasty with a cerebral protection device in place (E). CTA = computed tomographic angiography, ICA = internal carotid artery.

Mentions: The median duration of follow-up was 22 months (range: 3–72 months). All patients were alive, and no one received any reintervention or surgical conversion. No stroke or TIA occurred during the follow-up period. Ten patients (83.3%) were asymptomatic; however, 1 patient (Patient No. 2) experienced no change in hoarseness from the preoperative status, and another patient (Patient No. 7) experienced slight dizziness. On the basis of the imaging information, no stent migration, stent fracture, endoleak, and aneurysm rupture were identified in this series. However, the rate of aneurysm sac thrombosis is 91.7% (11/12), except for 1 patient (Patient No. 5) with a small amount of contrast leaking into the aneurysm sac at 3 months. We chose an observation strategy for the patient because of a lack of aneurysm growth and no significant clinical symptoms. All stents were patent except for the covered stent in 1 patient (Patient No. 3), who developed hemodynamic restenosis 12 months after the procedure. An additional bare stent was placed in the segment of the restenosis after balloon angioplasty under the security of cerebral protection device (Fig. 3).


Endovascular stenting for extracranial carotid artery aneurysms
A 45-year-old male suffered from a minor stroke before being diagnosed with a dissecting aneurysm in a high location of the left ICA through CTA examination (A). Endovascular treatment was carried out with deployment of a 6 × 50 mm covered stent (Viabahn, W.L. Gore)(B). Follow-up CTA imaging at 12 months indicated that the level of in-stent restenosis was >70% (marked by white arrows in C). After angiographic assessment (D), an additional stent was placed in the segment of the restenotic lesion after balloon angioplasty with a cerebral protection device in place (E). 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 3: A 45-year-old male suffered from a minor stroke before being diagnosed with a dissecting aneurysm in a high location of the left ICA through CTA examination (A). Endovascular treatment was carried out with deployment of a 6 × 50 mm covered stent (Viabahn, W.L. Gore)(B). Follow-up CTA imaging at 12 months indicated that the level of in-stent restenosis was >70% (marked by white arrows in C). After angiographic assessment (D), an additional stent was placed in the segment of the restenotic lesion after balloon angioplasty with a cerebral protection device in place (E). CTA = computed tomographic angiography, ICA = internal carotid artery.
Mentions: The median duration of follow-up was 22 months (range: 3–72 months). All patients were alive, and no one received any reintervention or surgical conversion. No stroke or TIA occurred during the follow-up period. Ten patients (83.3%) were asymptomatic; however, 1 patient (Patient No. 2) experienced no change in hoarseness from the preoperative status, and another patient (Patient No. 7) experienced slight dizziness. On the basis of the imaging information, no stent migration, stent fracture, endoleak, and aneurysm rupture were identified in this series. However, the rate of aneurysm sac thrombosis is 91.7% (11/12), except for 1 patient (Patient No. 5) with a small amount of contrast leaking into the aneurysm sac at 3 months. We chose an observation strategy for the patient because of a lack of aneurysm growth and no significant clinical symptoms. All stents were patent except for the covered stent in 1 patient (Patient No. 3), who developed hemodynamic restenosis 12 months after the procedure. An additional bare stent was placed in the segment of the restenosis after balloon angioplasty under the security of cerebral protection device (Fig. 3).

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