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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Open Retrograde Stenting of Proximal Innominate and Common Carotid Artery Stenosis
Marvin Kapalla1, Albert Busch1, Steffen Wolk1
1Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden-TU Dresden, 01307 Dresden, Germany.
Insights
Open retrograde stenting for innominate artery (IA) or common carotid artery (CCA) stenosis is safe, with low early stroke risk. However, ongoing monitoring is crucial due to significant in-stent restenosis rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Cerebrovascular Disease
Background:
- Limited evidence exists for open retrograde stenting of innominate artery (IA) or common carotid artery (CCA) stenosis.
- These procedures are suspected to carry a high risk of stroke and death.
Purpose of the Study:
- To evaluate the outcomes of hybrid procedures involving open retrograde stenting of IA or CCA stenosis.
- To assess the safety and efficacy of this treatment approach.
Main Methods:
- A retrospective, monocentric study was conducted.
- Patients undergoing retrograde stenting of proximal IA and CCA stenosis via surgical cutdown between 2016 and 2023 were included.
- Procedures were performed with or without concomitant carotid endarterectomy (CEA).
Main Results:
- 33 patients were treated, with 67% undergoing stenting for CCA and 33% for IA stenosis.
- 61% had synchronous ipsilateral CEA for tandem lesions.
- No 30-day mortality was observed; the perioperative stroke rate was 3% with full recovery.
- Follow-up at 32 months revealed three late deaths (9.1%) and one symptomatic stent occlusion.
- 15.2% of patients required re-intervention for restenosis.
Conclusions:
- Open retrograde stenting for proximal IA or CCA stenosis, with or without CEA for tandem lesions, is safe with low early adverse events.
- Continuous follow-up is essential due to significant in-stent restenosis rates.
Purpose:
The evidence regarding the treatment of open retrograde stenting of innominate artery (IA) or common carotid artery stenosis (CCA) is limited, and is suspected to carry a high risk of stroke and death. Therefore, the objective of this study was to evaluate the outcomes of such hybrid procedures.
Methods:
A retrospective, monocentric study of all patients who underwent retrograde stenting of proximal IA and CCA stenosis via surgical cutdown of the CCA, with or without concomitant CEA, between 2016 and 2023 was performed.
Results:
Overall, 33 patients were treated. A total of 15 patients (45.5%) were male, with the mean age being 67 ± 9.1 years, and 58% (n = 19) of the patients presented with neurological symptoms. Open retrograde stenting was performed in 67% (n = 22) in ACC, and in 33% (n = 11) in IA stenosis. A total of 20 patients (61%) underwent retrograde stenting with synchronous ipsilateral CEA for concomitant stenosis of the carotid bifurcation. There was no 30-day mortality. The perioperative stroke rate was 3% (n = 1) with complete symptom recovery. During the follow up at 32 months (95% CI: 24-39), three late deaths (9.1%) and one symptomatic stent occlusion were observed and, in five patients (15.2%), re-intervention for restenosis was necessary.
Conclusions:
Open retrograde stenting for of proximal IA or CCA stenosis with or without CEA, in case of tandem carotid lesions, can be performed safely with a low rate of early adverse events. Continuous follow up examinations are necessary due to relevant instent re-stenosis rates.
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