Application of endovascular stent placement as a remedy for spontaneous isolated superior mesenteric artery dissection

Sun, Yuan; Chen, Zhaolei; Zhang, Xicheng

doi:10.1177/1708538113516445

Cited by 9 publications

(17 citation statements)

References 24 publications

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“…7,16 This obliteration of the side branches does not occur with the use of bare stents alone or stent assisted coiling, and so these techniques are widely used in the management of IMAD. 7,15,17 Previous studies of endovascular therapy have demonstrated a high technical success rate for both bare stents alone and stent assisted coiling; 7,8,15,17,18 although this study demonstrated similar results, the numbers are small and there is a risk of a type II statistical error. Studies with larger sample sizes are needed to validate the findings.…”

Section: Discussionsupporting

confidence: 50%

Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling

Jia

Chen

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Endovascular stenting has been used successfully in the management of symptomatic isolated mesenteric artery dissection (IMAD) aneurysms. However, no study has compared the use of bare stents alone versus stent assisted coiling in IMAD aneurysms. The results of this study indicate that bare stents alone and stent assisted coiling have high technical success rates and demonstrate good mid-term patency in patients with IMAD aneurysms. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysms. Objective: The aim was to evaluate the outcomes of endovascular treatment with bare stents alone versus stent assisted coiling in isolated mesenteric artery dissection (IMAD) aneurysms. Methods: Patients with an IMAD aneurysm who underwent endovascular stenting between February 2010 and February 2017 at one of three institutions were included in this study. Data regarding technical success, procedure time, symptom resolution, complications, changes in IMAD aneurysm, and stent patency were recorded. Results: A total of 38 patients (35 men) were included, 27 treated with bare stents alone and 11 treated with stent assisted coiling. Technical success was achieved in 100% of patients treated with bare stents and in 81.8% of those treated with stent assisted coiling (p ¼ 0.078). The mean procedure times were 62.6 AE 5.3 min for treatment with bare stents and 116.4 AE 8.4 min for stent assisted coiling (p < 0.001). A total of 23 patients had persistent symptoms before stenting; all symptoms were resolved within 3.0 AE 0.7 days. No procedure related major complications occurred. Over 30.2 AE 18.1 months of follow up, complete resolution of the IMAD aneurysm was achieved in all patients; good stent patency and in stent re-stenosis were achieved in 65.8% and 34.2% patients, respectively. There were no occlusions of the stented arteries. Conclusions: Bare stents alone and stent assisted coiling have high technical success rates and demonstrate good intermediate patency in patients with an IMAD aneurysm. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysm

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Section: Discussionsupporting

confidence: 50%

Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling

Jia

Chen

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…[1][2][3][4][5][6][7] Patients with ISMAD are at a high risk of suffering both the rupture of the dissection, and symptoms of mesenteric ischemia. [1][2][3][4][5][6][7][10][11][12] Since it is a rare condition, the exact risk factors, its incidence rate and natural course of disease progression, and optimal treatment strategies are still not definitively established. The first-line treatment for ISMAD is typically a conservative approach, which has been used in the majority of previous reports where it has been reported to be successful in 12.5% to 70.6% of the cases.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Bare Stenting for Isolated Superior Mesenteric Artery Dissection

Cao

Shi

et al. 2019

Vasc Endovascular Surg

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Purpose: To investigate the clinical outcomes of endovascular bare stenting in patients with symptomatic isolated superior mesenteric artery (SMA) dissection (ISMAD). Methods: This study was a retrospective analysis which included a total of 9 patients with symptomatic ISMAD (7 males and 2 females, age range: 48-67 years) who were treated with endovascular bare stenting. Data regarding basic patient clinical characteristics, e-technical success of the operation, and long-term patient outcomes were assessed. Results: Endovascular bare stenting was found to be technically successful in all patients. A total of 9 stents were inserted in these 9 patients. Five patients presented with stable false lumen and 4 patients presented with shrinking of false lumen after stenting. Both the trunk and branches of the SMA remained patent in all patients after stent insertion. There was no incidence of procedure-related complications, with all patients experiencing progressive symptom relief and subsequent symptom abatement within 1 week of the operation. Over a median 24 month follow-up period (range: 12-36 months), abdominal computed tomographic angiography revealed that all patients had obliterated dissections. In addition, there were no instances of stent obstruction, intestinal necrosis, or antiplatelet related bleeding during the follow-up period. Conclusions: Endovascular bare stenting was found to be a safe and effective treatment for patients with ISMAD.

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“…5,[16][17][18] Twenty-two patients (18.1%) underwent this treatment option in whom the symptomatology was resolved at the end of follow-up period. Pharmaceutical treatment was mentioned in five studies 5,13,16,18,19 with 21 (17.3%) patients. Out of 21 patients, anticoagulants using low molecular weight heparin (LMWH) were used in 11 patients (52.3%), while antiplatelet agents in 6 (28.5%) patients.…”

Section: Asymptomatic Patientsmentioning

confidence: 99%

“…Less applicable diagnostic modalities included ultrasonography 18 and the magnetic resonance angiography (MRA) 20,36 while digital subtraction angiography (DSA) was performed only in four studies. 20,22,28,29 The imaging classification system of the SISMAD proposed by Sakamoto et al 6 was used by 14 studies, 6,16,18,19,21,[23][24][25]27,29,31,32,35,37 the modified by Yun classification, 8 was used by four studies, 15,22,26,28 while two studies 5,34 did not report the classification system used. The total number of stents used for endovascular treatment of SISMAD among the eligible studies was 86.…”

Section: Conservative Treatmentmentioning

confidence: 99%

Spontaneous isolated superior mesenteric artery dissection: Systematic review and meta-analysis

et al. 2019

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Objectives Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare disease with an incidence of 0.06%. The purpose of the meta-analysis was to identify the outcomes associated with the various treatment options in the management of asymptomatic and symptomatic patients with SISMAD. Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library. Endpoints were outcome of asymptomatic patients treated conservatively, resolution of symptoms according to the treatment approach, rate of symptomatic patients switched from conservative to the endovascular and/or open repair, characteristics of the dissected lesion, and findings regarding the remodeling of superior mesenteric artery. Results We identified 30 studies including 729 patients. Among them, 608 (83.4%) were symptomatic and were managed with conservative (438/72%), and/or endovascular (139/22.8%) and/or open treatment (31/5%). The remaining were asymptomatic and they were treated solely conservatively. A high rate of resolution of symptoms (92.8%) was noted for patients treated conservatively. Conversion from conservative treatment to either endovascular or open procedure was required in 12.3% and 4.4%, respectively. Resolution of symptoms was observed in 100% for those treated with open procedure and 88.8% for those treated endovascularly. The pooled rate of bowel ischemia in patients treated conservatively was 3.75% (95% confidence interval = 1.15–7.27). Complete remodeling was achieved in 32% and partial in 26% of those who were treated conservatively. Conclusions The majority of symptomatic patients with SISAMD were treated conservatively and showed an uncomplicated course and only a small percentage required conversion to endovascular or open repair. This might highlight the benign course of the disease.

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Application of endovascular stent placement as a remedy for spontaneous isolated superior mesenteric artery dissection

Abstract: Endovascular stent placement is a simple and safe alternative to aggressive surgery or uncertain observation.

Cited by 9 publications

References 24 publications

Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling

Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling

Endovascular Bare Stenting for Isolated Superior Mesenteric Artery Dissection

Spontaneous isolated superior mesenteric artery dissection: Systematic review and meta-analysis

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