Stent-graft treatment of traumatic carotid artery dissecting pseudoaneurysm

Introduction

Traumatic pseudoaneurysm of the internal carotid artery (ICA) is a rare but serious complication following blunt or penetrating trauma. These lesions are difficult to repair surgically. Endovascular management, including parent vessel occlusion, bare stent placement, and stent-assisted coil placement, are reported to be safe and effective but have certain disadvantages. Placement of covered stent grafts has been recently reported but without enough follow-up results to achieve consensus.

Methods

In this investigation, we present our experience with seven cases of traumatic ICA dissecting pseudoaneurysm treated with stent graft with follow-up between 1 and 33 months.

Results

Among the seven patients, one patient died due to septic shock 7 days after stenting. Follow-up angiography or Doppler ultrasound of the other six patients revealed optimal result with occluded pseudoaneurysm without restenosis of the ICA.

Conclusions

Our results suggest that placement of stent grafts is a safe and effective method for treating ICA traumatic-dissecting pseudoaneurysm.     

Fracture of a nitinol carotid artery stent that caused restenosis

The placement of self-expanding nitinol stents in the carotid artery is rapidly emerging as a minimally invasive alternative in the treatment of cervical carotid artery occlusive disease. Fractures of balloon-expandable stents after placement in the carotid artery have been previously documented. The authors report on a single case of early stent fracture and complete mid-body disruption of a self-expanding stent associated with a significant restenosis necessitating repeat intervention after carotid artery stent placement for a de novo atherosclerotic lesion.     

Double stent technique for the treatment of an internal carotid artery pseudoaneurysm caused by zone III stab injury

A 77-year-old man was transferred to the hospital with swelling of his neck and oropharynx after a stab injury to his oral cavity with pruning shears. Findings at complete neurologic examination were normal. Contrast-enhanced computed tomography (CT) and angiography revealed a pseudoaneurysm at the pharyngeal portion of the right internal carotid artery. Endovascular treatment was undertaken by using the double bare stent technique. The pseudoaneurysm was completely occluded immediately after the procedure. There were no complications. There were no further symptoms or evidence of recurrence of the aneurysm during the 18-month follow-up period. The double bare stent technique is safe and effective for the treatment of zone III carotid artery stab injuries.     

Giant cervical internal carotid artery pseudoaneurysm in a child: endovascular treatment

We report a child with a giant upper cervical internal carotid artery pseudoaneurysm presenting with dysphagia, respiratory distress and a sentinel mild epistaxis, then massive epistaxis. Rupture of the pseudoaneurysm during treatment occurred, as in one reported case. Prompt endovascular treatment yielded a good outcome.     

Clinical results of carotid artery stenting with a nitinol self-expanding stent (SMART stent)

Our objective was to assess the technical feasibility and the clinical results of internal carotid artery (ICA) stenting using a nitinol self-expanding stent (SMART stent). In 13 patients 13 high-grade stenoses of the internal carotid artery were treated via an implantation of a SMART stent. In all cases a predilation of the stenosis and a postdilation within the stent were performed. Follow-up examinations were carried out in all patients after a period of 6 months. In each case the implantation of the stent was performed without technical complications. In 12 of 13 cases the stent was placed in the patients' internal carotid artery, in 1 case from the internal to the common carotid artery (CCA). The average degree of stenosis of 78% (70-95%) was reduced to an average of 2.8% (0-21%). The 6-month follow-up angiography showed an average degree of restenosis of 11.8% (0-29%) in 8 of 13 patients. Duplex sonography in the remaining 5 patients demonstrated patent stents. One patient showed brief neurological symptoms during the intervention. No further complications occurred during follow-up time. Treatment of internal carotid artery stenosis with the SMART stent seems technically feasible, safe, and promises long-term patency.     

Life-threatening common carotid artery blowout: rescue treatment with a newly designed self-expanding covered nitinol stent

Carotid blowout is a devastating complication in patients with head and neck malignancy. A covered stent offers an alternative to treatment of a carotid blowout patient thought to be at high risk for surgery or carotid occlusion. Stent placement in the common carotid artery or carotid bulb is a technical challenge because of large luminal diameter and luminal calibre discrepancy between internal carotid artery and common carotid artery. We present four patients with common carotid rupture and massive bleeding who were treated with self-expanding covered stents, among them, two cases were treated with newly designed self-expanding polytetrafluoroethylene (PTFE)-covered nitinol stents.     

Outcome of mechanical thrombectomy with Solitaire stent as first-line intra-arterial treatment in intracranial internal carotid artery occlusion

Introduction

Acute stroke from occlusion of the intracranial internal carotid artery (ICA) is associated with a poor clinical outcome despite a thrombolytic treatment. The purpose of this study was to evaluate the outcome of mechanical thrombectomy using the Solitaire stent for the treatment of acute stroke patients with intracranial ICA occlusion.

Methods

A total of 104 consecutive patients with acute stroke were treated with mechanical thrombectomy using the Solitaire stent as a first-line intra-arterial treatment. We retrospectively reviewed data from 26 of these patients who presented with acute stroke attributable to intracranial ICA occlusion. Rescue treatments in cases of failed Solitaire thrombectomy included intra-arterial urokinase, angioplasty, and forced suction thrombectomy. Successful recanalization was defined as thrombolysis in cerebral ischemia grades 2b to 3. Outcome measure was the modified Rankin Scale (mRS) score of 0–2 at 3 months.

Results

Successful recanalization was achieved in 77 % (20/26) of patients. Recanalization was achieved with the Solitaire stent alone in 69 % (18/26) of patients. Ten patients (39 %) had a good clinical outcome (mRS score of 0–2) at 3 months. There was a good outcome in 50 % of patients (10/20) with recanalization and no good outcome in patients (0/6) without recanalization (P?=?0.027). None of eight patients who received rescue treatments showed a good outcome. No symptomatic intracerebral hemorrhage occurred. Mortality was 8 % (2/26) at 3 months.

Conclusion

Mechanical thrombectomy using the Solitaire stent can achieve a high rate of successful recanalization and a very low rate of symptomatic hemorrhage and thus improve a clinical outcome in patients with acute intracranial ICA occlusion.     

Post-traumatic dissecting aneurysm of extracranial internal carotid artery: endovascular treatment with stenting

Traumatic internal carotid dissection occurs frequently in motor vehicle accidents, typically extracranially, close to the skull base. Dissection may lead to stenosis or occlusion of the vessel, possibly with a pseudoaneurysm, symptoms ranging from neck pain to neurological deficits. In symptomatic patients and in cases of pseudoaneurysm, when conservative medical treatment fails, surgery or endovascular treatment are indicated. We report a post-traumatic dissecting aneurysm of the extracranial internal carotid artery successfully treated with stenting via a transfemoral approach. Received: 5 November 1998 Accepted: 5 December 1998     

Heparin-bonded stent graft placement for treatment of massive epistaxis from ruptured radiation-induced internal carotid artery pseudoaneurysm: A case report

Rupture of an internal carotid artery (ICA) pseudoaneurysm is a rare but life-threatening complication of irradiation therapy for a nasopharyngeal carcinoma (NPC). A 36-year-old man had a history of NPC treated with radiotherapy 8 years previously. He was admitted to the hospital because of severe repetitive epistaxis with hemodynamically instablility. An emergent angiography showed the left ICA pseudoaneurysm at the petrous portion (C2 segment). The patient was successfully treated by a new-generation heparin-bonded stent graft without any complication. Emergent stent graft placement is effective in stopping hemorrhage and is therefore a life-saving intervention. Long-term follow-up is necessary to look out for delayed post-treatment complications.     

Willis覆膜支架治疗颅段颈内动脉动脉瘤的前瞻性研究

目的评价Willis覆膜支架治疗颅段颈内动脉(ICA)动脉瘤的柔顺性和疗效。方法31例患者33枚颅段ICA(CICA)动脉瘤患者接受Willis覆膜支架治疗。根据血管造影表现,分为完全栓塞和不完全栓塞。术后第1,3,6,12个月及之后每年1次随访复查并收集最初及最终造影结果、死亡率、致残率及最终临床结果等数据。结果42枚覆膜支架中41枚顺利通过ICA并成功释放,成功率97.6%(95%CI:93%～102%)。术后即刻造影显示,23例患者中25枚为完全栓塞,占78.1%(95%CI:63%～93%);7例患者7枚动脉瘤为不完全栓塞(21.9%)。随访血管造影示27例患者共31枚动脉瘤,其中29枚完全栓塞,占93.5%(95%CI:84%～103%);2例为不完全栓塞(6.5%),其中2例患者出现轻度支架内狭窄。临床随访显示15例患者痊愈,14例症状改善。结论初步结果显示,Willis覆膜支架治疗CICA动脉瘤有效且具有良好的柔顺性,但仍需长期随访及大样本临床研究。     

血管内治疗颈内动脉颅外段伴同侧颅内动脉急性串联闭塞

目的探讨颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者血管内治疗方法 ,评估其疗效和安全性。方法回顾性分析2015年1月至2019年12月在南阳市中心医院接受血管内治疗的63例颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者临床资料。根据治疗方式不同,分为顺行再通组(n=41)和逆行再通组(n=22)。采用改良溶栓治疗脑梗死(mTICI)血流分级判断术后血管再通程度,改良Rankin量表(mRS)评分评估术后90 d临床预后。结果两组患者年龄、性别、伴高血压病、伴糖尿病、伴心房颤动、吸烟史、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT评分(ASPECTS)、脑卒中病因等差异均无统计学意义(均P>0.05)。顺行再通组、逆行再通组分别有16例(39.0%)、15例(68.2%)接受急诊颈内动脉起始段支架植入(P=0.027),穿刺至再通时间分别为(138+55) min、(120+47) min(P<0.01),90 d恢复良好(mRS评分≤2分)分别有17例(41.5%)、15例(68.2%)(P=0.043),差异均有统计学意义。结论血管...     

Evaluation of distal extracranial internal carotid artery by transoral carotid ultrasonography in patients with severe carotid stenosis

BACKGROUND AND PURPOSE: Conventional ultrasonography techniques do not allow visualization of the distal cervical segment of the internal carotid artery (ICA). In a study of patients with severe ICA stenosis, we performed transoral carotid ultrasonography (TOCU) to assess its ability to image this segment of the artery. METHODS: The study participants consisted of 20 consecutive patients who had severe carotid stenosis and who underwent carotid endarterectomy between 1999 and 2000. TOCU, conventional carotid ultrasonography, and cerebral angiography were prospectively performed before and after carotid endarterectomy. RESULTS: In all patients, the distal portion of the ICA could be clearly detected by B mode using TOCU and no plaque was observed. The diameter of the distal portion of the ICA significantly increased after carotid endarterectomy (3.9 +/- 0.5 mm [mean +/- SD]), compared with before (3.5 +/- 0.8 mm), when it was estimated by TOCU (P <.01). In seven patients, the postoperative diameter of the distal ICA increased >10%. The mean increase in the postoperative diameter was estimated to be 15.0 +/- 23.0% by TOCU, which significantly correlated with the findings (23.9 +/- 33.7%) based on cerebral angiography (P <.01). The diameter increased >10% postoperatively in 71% of the patients with the degree of cross-sectional stenosis >95% as shown by carotid ultrasonography and in 86% of the patients whose preoperative diameter was <3.0 mm. CONCLUSION: TOCU provides additional information regarding the characteristics of the distal ICA that can be obtained neither by conventional carotid ultrasonography nor by angiography.     

Willis覆膜支架治疗颈内动脉血泡样动脉瘤疗效的Meta分析

【摘要】 目的 系统性分析Willis覆膜支架治疗颈内动脉血泡样动脉瘤的安全性和有效性。方法 使用计算机检索中国知网、维普中文期刊全文数据库、万方数据库、中国生物医学文献数据库（CBM）、PubMed以及Embases数据库,筛选出Willis覆膜支架治疗颈内动脉血泡样动脉瘤相关文献,由两名评价员独立筛选、评价文献并提取资料,使用STATA 14软件对相关数据进行分析。结果 共16篇非随机自身前后对照研究文献被纳入,包括208例颈内动脉血泡样动脉瘤。Meta分析显示,Willis覆膜支架治疗颈内动脉血泡样动脉瘤的最终完全闭塞率为99%［95%CI（0.96,1.00）］,存在内漏率3%（手术结束时）［95%CI（0.00,0.07）］,载瘤动脉通畅率100%（手术结束时）［95%CI（0.99,1）］ ,术中或术后出血率1%［95%CI（0.00,0.04）］,术后大面积脑梗死率0%［95%CI（0.00,0.00）］,随访期间出现载瘤动脉重度狭窄或闭塞率0%［95%CI（0.00,0.02）］,最后随访良好率99%［95%CI（0.97,1.00）］。结论 Willis覆膜支架治疗颈内动脉血泡样动脉瘤完全闭塞率、载瘤动脉通畅率、术后随访恢复良好率很高,术中内漏率、围手术期出血、大面积脑梗死、随访期间载瘤动脉重度狭窄或闭塞率很低,安全和有效性很高,具有很好的使用性。     

Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent

BACKGROUND AND PURPOSE: A new neurovascular microstent, the Cordis Enterprise stent, composed of nitinol, with a closed cell design, was specifically developed for the treatment of wide-necked intracranial cerebral aneurysms. The purpose of this study was to evaluate the safety, feasibility, and initial clinical results of using this device in patients. METHODS: In clinical evaluation, five patients ranging in age from 54 to 71 years were electively treated. The smallest aneurysm measured 3.3 x 2.9 mm, and the largest aneurysm measured 10.6 x 8.5 mm (neck and height measurements). RESULTS: All five cases (100%) were technically successful without complications. In each case, the stent was accurately placed in the desired location, immediately followed by coil embolization to the desired degree of occlusion with a satisfactory result. The poststent and coil-occlusion angiogram demonstrated excellent blood flow across the stent, with satisfactory positioning of the coils within the aneurysm in all cases (100%). No patient suffered any clinical or neurologic complications, and all were discharged 1-3 days postprocedure, in stable condition with no new neurologic deficits. CONCLUSION: In early clinical studies, the Cordis Enterprise stent performed well. The stent was able to be well visualized, deployed easily, could be repositioned if needed, and was accurately placed without technical difficulties. The closed cell design allowed all coils to be placed within the aneurysm and remain outside the flow of the parent artery. No periprocedural complications were encountered.     

Multicenter evaluation of a self-expanding carotid stent system with distal protection in the treatment of carotid stenosis

PURPOSE: Carotid artery stent placement may be limited by the embolization of atheromatous material. We evaluated the safety and feasibility of the Medtronic Self-Expanding Carotid Stent (Exponent) in combination with the Medtronic Interceptor Carotid Filter System for the treatment of carotid stenosis among patients at high risk for carotid endarterectomy. METHODS: Patients at high risk for carotid endarterectomy but amenable to percutaneous treatment with stent placement were enrolled. Clinical follow-up was performed at 30 days and 6 and 12 months postprocedure. The National Institutes of Health Stroke Scale was assessed before and within 3 days postprocedure and at 30 days and 6 months postprocedure. Angiography was performed pre- and postprocedure, and carotid duplex scans were performed at baseline and at 30 days and 6 months. RESULTS: Fifty-two carotid procedures were performed in 51 patients (mean age, 69 years; 84% of patients were men). The major adverse event (MAE) rate (death, stroke, and myocardial infarction [MI]) at 30 days was 5.9%: 2 strokes and a single death from periprocedural MI. MAE rates after 6 and 12 months were 5.9% and 11.8%, respectively. The delivery success rate was 94.2% (49/52) for the Interceptor Filter System and 95.9% (47/49) for the Exponent Stent. The mean diameter stenosis of the target lesion was reduced from 62.4% preprocedure to 21.2% postprocedure. CONCLUSION: High delivery success rates were achieved with a low rate of MAE (death, stroke, or MI) in a high-risk population. Treatment of carotid artery disease with the Exponent Carotid Stent combined with distal protection from the Interceptor Filter System is effective and safe.     

弹簧圈闭塞颈内动脉治疗颅内巨大动脉瘤的护理

目的总结介入治疗颈内动脉巨大动脉瘤中球囊闭塞试验的重要性以及护理配合的经验。方法对12例采用弹簧圈闭塞颈内动脉方法治疗的患者进行术前、术中及术后的护理,包括心理护理,生命体征监测、并发症预防等。结果经过介入治疗及系统的护理,12例患者术后无病情加重及死亡,患者平均观察9d后出院。随访4～12个月,其中7例未见不适,4例复查动脉瘤消失,1例患者有不适,DSA复查未见异常。结论对行弹簧圈闭塞颈内动脉方法治疗动脉瘤的患者,介入手术过程中的生命体征的监护、并发症预防及规范的护理程序等均是保证手术完成的关键。     

Hyperperfusion syndrome after external carotid artery stent placement in a case of bilateral internal carotid occlusion and external carotid stenosis

The authors describe a patient with bilateral internal carotid artery occlusion, bilateral external carotid artery (ECA) stenosis, and suboptimal collateral circulation from the right ECA to the right cerebral hemisphere. The patient manifested clinical and radiographic signs of hyperperfusion syndrome following stent placement in the right ECA. This represents a rare case of a stent placed in the ECA of a patient in addition to the development of hyperperfusion syndrome after the procedure.     

椎动脉颅内段夹层瘤应用覆膜支架成形一例

患者男,56岁.因突发左侧额、面部、牙床剧烈疼痛17年,加重1个月于2007年1月入院.疼痛剧烈,性质无法描述;重体力活动、吃饭时疼痛消失.剧烈疼痛时感颈硬,伴左侧肩痛.白行用手按压左侧耳后乳突处可止痛.10余年前感饮水可诱发疼痛,后逐渐不诱发.曾就诊多所医院,诊断为"左侧三叉神经痛",给予口服卡马西平,可以缓解疼痛,后因查出肝功能受损而停止服药(具体不详).既往体健.体检一般状况良好.颈软,左侧额、顶、面部痛觉减退,温度觉无变化.MRI见左侧椎动脉颅内段异常影像.颅内动脉DSA见左侧椎动脉颅内段小脑后下动脉远端、近基底动脉汇合处异常囊状显影,8 mm×10 mm大小,近端载瘤动脉狭窄.诊断为"椎动脉颅内段夹层动脉瘤".     

Endovascular treatment of a pulmonary artery pseudoaneurysm with a stent graft: report of two cases

Two patients with hemoptysis secondary to pulmonary artery pseudoaneurysm were treated by endovascular placement of stent grafts. Aneurysms were effectively excluded and hemoptysis stopped. Stent grafts were occluded in both patients. However, endovascular treatment of the pulmonary artery pseudoaneurysm with a stent graft is a safe alternative to coil embolization or surgery.