Stent-Graft Treatment of Pseudoaneurysms and Arteriovenous Fistulae in the Carotid Artery

Abstract

The purpose of this study was to assess the safety and efficacy of stent-graft placement in the management of arteriovenous fistulae (AVF) and pseudoaneurysms (PAs) involving the carotid artery (CA). Twenty-two patients (16 men, 6 women) with a CA AVF (n = 5) or PA (n = 17) owing to a gunshot or stab wound, carotid endarterectomy, blunt trauma, a tumor, spontaneous dissection, or a central venous catheter were treated with percutaneous placement of stent grafts. The patients presented with tumor, bruit, headache, mouth and tracheostomy bleeding, transitory hemiparesis, seizure, or stroke. Diagnoses were made by using computed tomographic angiography (CTA) and digital subtraction angiography. Fourteen lesions were in the common CA; eight were in the internal CA. Homemade devices and stent grafts from a variety of manufacturers were employed. Follow-up evaluations included clinical, CTA, and Doppler ultrasound assessments. All patients had resolution of the PA or AVF. In one patient with a large petrous PA, acute occlusion of the CA developed after placement of three balloon-expandable stent grafts, but there were no neurologic complications because the circle of Willis was functional. During follow-up ranging from 2 months to 13 years, asymptomatic 90% stenosis owing to stent compression was observed on Doppler ultrasound and angiographic examinations in a patient with an autologous vein-covered stent graft in the internal CA. Three other patients died of causes unrelated to stent-graft placement. In all other patients, the stent graft remained patent. Our results indicate that stent grafting is an acceptable alternative to surgery in the treatment of AVF and PAs in the CA.

Endovascular treatment of recurrent intracranial aneurysms with re-coiling or covered stents

“…In comparison with established endovascular embolisation techniques, the covered stent has two distinguished advantages: higher overall total occlusion rate and lower recanalisation rate; both of these have been confirmed by our studies and many other published series 16 20 21 31 32. Our initial overall total occlusion rate of 72.7% is at the high end of the reported range of 35–76.8%3 4 5 6 7 8 whereas our final overall total occlusion rate of 100% is above the high end of the reported range of 50.7–87.8%7 8 9 10 11 12 13 14; moreover, the recanalisation rate was 0.…”

A New Covered Stent Designed for Intracranial Vasculature: Application in the Management of Pseudoaneurysms of the Cranial Internal Carotid Artery

“…There have only been 25 reported cases of intracranial pseudoaneurysms treated with covered stents and only 4 kinds of covered stents (ie, autologous vein-covered stents, Symbiot covered stent, Jostent covered stent, and carotid Wallstent) mentioned in the literature since 1990. 2,[20][21][22][23] The Jostent covered stent (Abbott Vascular, Redwood City, Calif) is a composite balloon-expandable stent with an ultrathin layer of ePTFE sandwiched between 2 stainless steel stents, and this device is manually compressed over a conventional angioplasty balloon. 2,24 The Symbiot covered stent (Boston Scientific, Natick, Mass) is a small, nitinol selfexpandable stent that was originally designed for vascular use in coronary saphenous vein grafts.…”

Placement of Covered Stents for the Treatment of Direct Carotid Cavernous Fistulas

“…[17][18][19][20][21] Recently, covered stents have been used for the treatment of aneurysms, pseudoaneurysms, arterial dissections, and arteriovenous fistulas as well. 2,[5][6][7][8][22][23][24][25][26] Although several varieties of covered stents have been used by the neurovascular community, only the Willis covered stent (MicroPort, Shanghai, China) reported by Li et al 22 is specially designed for intracranial vasculature use. The Jostent GraftMaster Coronary Stent Graft used in this series is composed of a sandwich construction of 2 bare stainless steel stents with a thin layer of polytetrafluoroethylene (PTFE) in between.…”