Delayed stenosis following placement of a polyethylene terephthalate endograft in the cervical carotid artery

Abstract

Three patients with carotid artery (CA) pseudoaneurysms were treated using four polyethylene terephthalate endografts (Wallgraft endoprostheses). Two patients received a single graft and one patient with bilateral pseudoaneurysms received two grafts. Complete occlusion of the pseudoaneurysm with patency of the arterial lumen was achieved following endograft placement in all patients. The clinical follow-up interval ranged from 12 to 18 months and included angiography or ultrasonography studies or both. One patient experienced neurological symptoms, and in-graft stenosis ranging from 50 to 100% occurred in three of the four grafts. Although the Wallgraft endoprosthesis produced good initial results for the treatment of cervical CA pseudoaneurysms, as demonstrated on radiography, it was associated with a high rate of stenosis or occlusion in all three patients.

Occlusion of Experimental Aneurysms with Heparin-loaded, Microporous Stent Grafts

“…At 1 and 3 months after occlusion of the aneurysms with stent graft implantation, histopathological examinations revealed mature fibrous connective tissue and collagen (indicating well-organized thrombus) filling each aneurysmal lumen and satisfactory patency of the parent carotid arteries, without stenosis. Delayed stenosis was reported at 12 to 18 months after placement of a polyethylene terephthalate endograft in the cervical carotid artery (35). We require a long-term follow-up study, although those results were attributable to the use of a thick nonporous Dacron graft, which was different from our graft with respect to materials, thickness, and pores.…”

“…In this study, the orifice was covered with an endothelial layer as early as 7 days after stent placement. Restoration of the endothelium inhibits the accumulation of smooth muscle cells after denuding arterial injuries (35), and stimulation of endothelial restoration maximizes the regression of intimal hyperplasia (4). Combination therapy with heparin, aspirin, dipyridamole, and dextran was demonstrated to reliably prevent acute thrombotic occlusion of stents in a canine model (28).…”

Patients with head and neck cancers and associated postirradiated carotid blowout syndrome: Endovascular therapeutic methods and outcomes

“…1,18 Reconstructive management, however, also carries the risk of thromboembolism and procedurally related complications such as vascular dissection. 11,13 These complications may be caused by inadequate antithrombotic medication treatment of the patients or product characteristics of the devices. The development of a new design of self-expandable stent graft with a less thrombogenic surface, higher flexibility, and lower profile is indicated to improve technical safety of reconstructive endovascular management.…”

“…Some authors report it as promising in treating CBS in patients at risk of CA occlusion 8,10 ; however, some studies have described unfavorable long-term outcomes. 5,[11][12][13] Therefore, the purpose of this study was to compare the technical and hemostatic outcomes of endovascular reconstruction using self-expandable stent grafts with those of endovascular deconstruction using balloons, coils, or acrylic adhesive in the management of CBS in patients with head and neck cancers. We also provide an assessment of the clinical severity in our patients compared with their angiographic findings to highlight the importance of early diagnosis and management of CBS.…”

Treatment of a Recurrent Internal Carotid Artery Pseudoaneurysm with the Wallgraft Endoprosthesis

“…To the best of our knowledge there have been seven reports describing the use of the Wallgraft prosthesis for the treatment of carotid artery pseudoaneurysms of varying aetiologies in a total of 14 patients [4][5][6][7][8]16,17 . Clinical follow up was performed in all patients and ranged from one month to two years.…”