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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Intraoperative stenting for brachiocephalic and carotid artery stenosis
Ichiro Nakahara1, Toshio Higashi, Yasushi Iwamuro
1Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka 802-8555, Japan.
Insights
Intraoperative stenting offers a viable solution for brachiocephalic artery stenosis when standard surgical or percutaneous endovascular approaches are not feasible. This method demonstrated safe and effective treatment without complications in a small patient cohort.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Cerebrovascular Disease
Background:
- Brachiocephalic artery stenosis poses treatment challenges, with endovascular stenting as an alternative to carotid endarterectomy.
- Standard percutaneous approaches can be hindered by severe iliofemoral atherosclerosis or aortic disease.
Observation:
- A novel intraoperative stenting technique was employed in seven patients with brachiocephalic and cervical carotid artery stenosis.
- The stenting procedure involved an open cervical approach with sheath introducer placement and utilized distal protection in most cases.
Findings:
- All patients achieved successful stenosis dilation without immediate complications like stroke or hyperperfusion.
- No wound hematomas occurred despite antiplatelet and heparin therapy.
- One-year angiographic follow-up in five patients revealed no instances of restenosis.
Implications:
- Intraoperative stenting presents a safe and effective alternative for complex brachiocephalic artery stenosis cases.
- This approach expands treatment options for patients unsuitable for conventional surgical or endovascular interventions.
Objective:
Endovascular stenting is an alternative treatment for brachiocephalic artery stenosis, replacing standard surgical approaches such as carotid endarterectomy. However, a percutaneous approach may be difficult because various conditions such as severe arteriosclerosis of iliac or femoral arteries and aortic disease. We report our experience with intraoperative stenting for these lesions, presenting indications, strategy, and results.
Methods:
Seven patients underwent intraoperative stent placement via an open cervical approach. The sites of lesions included 1 innominate artery, 1 common carotid artery, and 5 cervical carotid arteries. Stenting was performed with a sheath introducer placed through a surgically exposed common carotid artery via a small skin incision or common carotid artery exposed for simultaneously performed carotid endarterectomy. Distal protection was used in 6 patients with an endovascular protective balloon or external clamping with forceps.
Results:
Sufficient dilation of stenosis was obtained in all cases. No complications such as transient ischemic attack, cerebral infarction, and hyperperfusion were encountered. Wound hematoma was not experienced despite perioperative antiplatelet therapy and heparinization during the procedure. Angiographic follow-up over 1 year showed no restenosis in 5 available patients.
Conclusion:
Intraoperative stenting may be an excellent alternative for patients in whom both direct surgical approach and standard percutaneous endovascular approach are not possible.