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Covered stent-graft repair of the brachiocephalic arteries: technical note
Arun Paul Amar1, George P Teitelbaum, Steven L Giannotta
1Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles 90033-1029, USA. amar@aya.yale.edu
Insights
Covered stent-grafts effectively repair cervical carotid and vertebral artery disruptions, maintaining blood flow and vessel integrity. These endovascular devices offer a versatile alternative for treating extracranial cerebrovascular disease.
Area of Science:
- Vascular Surgery
- Endovascular Therapy
- Cerebrovascular Disease
Background:
- Disruptions of the cervical carotid and vertebral arteries pose significant therapeutic challenges.
- Traditional treatments may involve vessel sacrifice, leading to potential complications.
Observation:
- Three patients presented with severe arterial wall defects: tumor invasion of the common carotid artery, vertebral arteriovenous fistula, and internal carotid artery pseudoaneurysm.
- These defects resulted from tumor invasion and penetrating neck trauma.
Findings:
- The Wallgraft endoprosthesis, a type of covered stent-graft, was successfully deployed in all three patients.
- The stent-graft repaired the arterial defects, preserving or restoring antegrade blood flow without neurological complications.
Implications:
- Covered stent-grafts provide a valuable alternative to parent vessel occlusion for treating extracranial cerebrovascular pathology.
- These devices expand endovascular treatment options for complex brachiocephalic arterial injuries and defects.
Objective:
The use of a covered stent-graft to repair disruptions of the cervical carotid and vertebral arteries is described. This device maintains vessel patency while effectively excluding pseudoaneurysms, arteriovenous fistulae, and other breaches in the integrity of the arterial wall.
Methods:
Patient 1 bled from a large rent in the proximal common carotid artery as a result of tumor invasion. Patient 2 developed a vertebral arteriovenous fistula after a stab injury to the neck. Patient 3 developed cerebral infarction and an enlarging pseudoaneurysm of the internal carotid artery, also after a stab wound to the neck.
Results:
All three patients were treated with the Wallgraft endoprosthesis (Boston Scientific, Watertown, MA). In each case, the vessel wall defect was repaired while antegrade flow through the artery was preserved or restored. No neurological complications occurred as a result of stent-graft deployment.
Conclusion:
Covered stent-grafts offer an alternative to endovascular occlusion of the parent vessel, thereby expanding the therapeutic options for patients with extracranial cerebrovascular disease. These three cases highlight the usefulness and versatility of these devices for endoluminal reconstruction of the brachiocephalic vasculature.