Pipeline Embolization Device for Treatment of Extracranial Internal Carotid Artery Pseudoaneurysms: A Multicenter Evaluation of Safety and Efficacy

Akinduro, Oluwaseun O.; Gopal, Neethu; Hasan, Tasneem F.; Nourollahzadeh, Emad; Vakharia, Kunal; Leacy, Reade De; Burkhardt, Jan‐Karl; Yamamoto, Junichi; Mocco, J; Castilla, Leonardo Rangel; Kan, Peter; Boulos, Alan S.; Levy, Elad I.; Tawk, Rabih G.

doi:10.1093/neuros/nyz548

Cited by 12 publications

(14 citation statements)

References 35 publications

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“…3,4 Flow diversion device has gradually become the preferred treatment for some carotid artery lesions in recent years; but, the technique also bears a risk of recurrence because the device cannot completely eliminate aneurysms immediately. 5 Covered stent grafts have been documented for the treatment of complex carotid artery lesions. [6][7][8][9][10][11] They not only provided immediate obliteration of the lesion but also preserved the normal lumen of the parent artery and promoted the growth and coverage of new endothelial cells 12 ; nevertheless, the challenges of thrombosis, stenosis, and the vessel structure may restrict the implantation.…”

Section: Introductionmentioning

confidence: 99%

Application of covered stent graft in the treatment of complex carotid artery lesions: A single center experience

et al. 2021

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Purpose To assess the clinical efficiency and imaging outcome of applying covered stent grafts for the treatment of complex carotid artery lesions. Method A total of 39 consecutive patients with carotid artery lesions treated with covered stent grafts at our institution from December 2016 to December 2019 were reviewed. Two kinds of stent including self-expandable covered stent (Viabahn; W. L. Gore & Associates) and balloon-expandable covered stent (Willis; Microport) were applied. The angiograms immediately after the procedure, perioperative complications, and follow-up outcomes were recorded. Result Based on imaging features, 11 patients exhibited pseudoaneurysms, 23 patients had blood blister-like aneurysms (BBAs), and five patients were carotid cavernous fistulas. A total of 40 stent implantations were performed, including nine Viabahn stents and 31 Willis stents. Two patients received double implants of Willis stents. Stent failed to perform for one patient due to tortuous parent artery. The angiography reports immediately after the procedure showed that the lesions in 36 patients were completely occluded, whereas two patients had minimal endoleaks. With respect to the occurrence of procedural complications, an aneurysm ruptured during the procedure in one case, which resulted in CCF, and acute in-stent thrombosis occurred in another case. Clinical and angiographic follow-up (11.2±2.4 months) sessions were conducted for 38 patients and a complete lesion exclusion was achieved in 36 patients. The minimal endoleak persisted in one patient and another patient experienced recurrence with stent migration, leading to ipsilateral blepharoptosis. However, none of the patients developed hemorrhage or ischemia and in-stent stenosis was not observed. Conclusion Covered stent grafts appear to be a safe and feasible for the treatment of complex carotid artery lesions. Despite the potential for stent delivery failure as well as endoleak and procedure-related complications, covered stent grafts should be considered when selecting the optimal treatment strategy.

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Section: Introductionmentioning

confidence: 99%

Application of covered stent graft in the treatment of complex carotid artery lesions: A single center experience

et al. 2021

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“…CAS is the most common method of EVT for type III dissections with the presence of persistent flow-limiting dissections, continued dissecting pseudoaneurysm enlargement, or persistent local symptoms. Stent and stent graft with or without the simultaneous use of coil embolization can modulate blood flow and reconstruct the parent artery 32 . Technical success was achieved in all type III dissections with EVT.…”

Section: Discussionmentioning

confidence: 99%

Classification and management strategy of spontaneous carotid artery dissection

Zhou,

Li,

Jiao

et al. 2023

Preprint

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Background and Purpose—Spontaneous carotid artery dissections (sCAD) are the main cause of stroke in young people. There is still a lack of clinical classification to guide the management of sCAD. We reviewed our experience with 179 sCAD patients and proposed a new classification for sCAD with prognostic and therapeutic significance. Methods—This is a retrospective review of prospectively collected data from June 2018 to June 2023 of sCAD patients treated at a large tertiary academic institution in an urban city in China. Depending on the degree of luminal narrowing and pseudoaneurysm formation on imaging, sCAD was classified into four types. Type IV dissections were divided into type IVA and type IVB dissections according to the presence of intracranial occlusion. Results—A total of 179 patients and 197 dissected arteries met the inclusion criteria. More than two-thirds of type I dissections are completely recanalized after antithrombotic therapy, and only one case (1.8%) had recurrent ischemic stroke. A total of 38 % of type II dissections and 73% of type III dissections received endovascular treatment (EVT) for persistent flow-limited dissections, enlargement of pseudoaneurysm, or aggravation of clinical symptoms despite antithrombotic therapy. Type IV dissections are more likely to lead to the occurrence of ischemic stroke, and presented with more severe symptoms. About 33% of type IVB dissections received emergent intervention due to intracranial occlusion or aggravation of symptoms after medical treatment. Conclusions—This study proposes a novel and more comprehensive classification method and management strategy for sCAD. Antithrombotic therapy is beneficial to reduce the risk of recurrent stroke for stable sCAD like type I. Non-emergent EVT can be an alternative therapeutic approach for patients who meet indications as in type II to IVA. Urgent procedure with neurovascular intervention might be needed in those with type IVB SCAD. The short-term results of EVT for sCAD are encouraging, and long-term device-related and functional outcome should be elucidated.

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“…Advancements in endovascular techniques have treatment options for EICAs, particularly those in high cervical segments. Endovascular methods, including covered stents, stent-assisted embolization, and ow-diverting devices [22][23][24] , offer alternatives to open surgery, particularly in cases where conventional exposure is challenging [10] . However, the limitations of endovascular treatment are evident, with reported risks of stroke, aneurysm rupture, and vascular injury [25] .…”

Section: Endovascular Intervention: Selective Yet Risk-ladenmentioning

confidence: 99%

External carotid artery-to-petrous internal carotid artery radial artery graft bypass for a giant high cervical aneurysm

Gao,

Guo,

Tong

2024

Preprint

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Objective To investigate optimal treatment strategies for giant high-cervical internal carotid artery aneurysms. Methods A retrospective analysis was conducted, examining clinical data, surgical approaches, and postoperative outcomes in a case involving a patient with a giant high-cervical internal carotid artery aneurysm. Additionally, pertinent literature was reviewed to contextualize the findings. Results A 52-year-old male patient presented with a one-year history of intermittent coughing, exacerbated by a two-month history of headaches. Digital Subtraction Angiography (DSA) revealed the presence of a giant high-cervical internal carotid artery aneurysm on the right side. The patient underwent an external carotid artery-radial artery-internal carotid artery petrosal segment bypass and aneurysm isolation surgery. Postoperative angiography demonstrated the disappearance of the aneurysm and patency of the bypass. Notably, there were no occurrences of new cerebral ischemia or infarction, no manifestation of new neurological dysfunction, and a marked improvement in the patient's original symptoms. Conclusion The treatment of giant high-cervical internal carotid artery aneurysms necessitates cerebral vascular bypass surgery, with the external carotid artery-radial artery-internal carotid artery petrosal bone segment bypass proving to be an efficacious and preferable therapeutic modality for such lesions.

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Pipeline Embolization Device for Treatment of Extracranial Internal Carotid Artery Pseudoaneurysms: A Multicenter Evaluation of Safety and Efficacy

Cited by 12 publications

References 35 publications

Application of covered stent graft in the treatment of complex carotid artery lesions: A single center experience

Application of covered stent graft in the treatment of complex carotid artery lesions: A single center experience

Classification and management strategy of spontaneous carotid artery dissection

External carotid artery-to-petrous internal carotid artery radial artery graft bypass for a giant high cervical aneurysm

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