Stent-grafts in the Treatment of Emergent or Urgent Carotid Artery Disease

Review of 25 Cases

Hanno Hoppe, Stanley L. Barnwell, Gary Nesbit, Bryan Petersen

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Purpose: To report the authors' initial experience with carotid artery stent-grafts in a comparatively large patient series for the treatment of acute bleeding and impending rupture or the prevention of distal embolization. Materials and Methods: This retrospective study was approved by the institutional review boards and performed according to HIPPA standards. Twenty-five patients were treated with 27 carotid artery stent-grafts (Gore Viabahn, n = 10; Bard Fluency, n = 9; polytetrafluoroethylene-covered Palmaz, n = 5; and Wallgraft, n = 3). Thirteen stent-grafts were placed in patients with carotid blow-out syndrome (including three patients with carotid-airway fistula), 12 in patients with either pseudoaneurysm (n = 9) or true aneurysm (n = 3), and two in patients with intractable high-grade bare stent restenosis. Results: The technical success rate was 100% (27 of 27 cases). No acute procedural transient ischemic attacks or strokes occurred. Procedural dissections occurred in two of the 27 cases (7.4%). Short-term complications occurred in three of the 27 cases (11%) (repeat hemorrhage, n = 2; common carotid artery occlusion, n = 1). The overall patient mortality rate was 36% (nine of 25 patients, all with carotid blow-out syndrome). Six-month follow-up in 15 of the 16 living patients demonstrated widely patent stent-grafts. Two patients with pseudoaneurysm also demonstrated patent stents at 18- and 33-month follow-up. Conclusions: Stent-grafts may be useful in the treatment of carotid artery bleeding syndrome, aneurysm, and stenosis, with a high procedural success rate in selected cases. The results of mid-term follow-up are encouraging, but results of long-term follow-up must be evaluated in future studies.

Original languageEnglish (US)
Pages (from-to)31-41
Number of pages11
JournalJournal of Vascular and Interventional Radiology
Volume19
Issue number1
DOIs
StatePublished - Jan 2008

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Carotid Artery Diseases
Stents
Transplants
Carotid Arteries
Therapeutics
False Aneurysm
Hemorrhage
Aneurysm
Research Ethics Committees
Common Carotid Artery
Transient Ischemic Attack
Polytetrafluoroethylene
Fistula
Dissection
Rupture
Pathologic Constriction
Retrospective Studies
Stroke

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Stent-grafts in the Treatment of Emergent or Urgent Carotid Artery Disease : Review of 25 Cases. / Hoppe, Hanno; Barnwell, Stanley L.; Nesbit, Gary; Petersen, Bryan.

In: Journal of Vascular and Interventional Radiology, Vol. 19, No. 1, 01.2008, p. 31-41.

Research output: Contribution to journalArticle

Hoppe, Hanno ; Barnwell, Stanley L. ; Nesbit, Gary ; Petersen, Bryan. / Stent-grafts in the Treatment of Emergent or Urgent Carotid Artery Disease : Review of 25 Cases. In: Journal of Vascular and Interventional Radiology. 2008 ; Vol. 19, No. 1. pp. 31-41.
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abstract = "Purpose: To report the authors' initial experience with carotid artery stent-grafts in a comparatively large patient series for the treatment of acute bleeding and impending rupture or the prevention of distal embolization. Materials and Methods: This retrospective study was approved by the institutional review boards and performed according to HIPPA standards. Twenty-five patients were treated with 27 carotid artery stent-grafts (Gore Viabahn, n = 10; Bard Fluency, n = 9; polytetrafluoroethylene-covered Palmaz, n = 5; and Wallgraft, n = 3). Thirteen stent-grafts were placed in patients with carotid blow-out syndrome (including three patients with carotid-airway fistula), 12 in patients with either pseudoaneurysm (n = 9) or true aneurysm (n = 3), and two in patients with intractable high-grade bare stent restenosis. Results: The technical success rate was 100{\%} (27 of 27 cases). No acute procedural transient ischemic attacks or strokes occurred. Procedural dissections occurred in two of the 27 cases (7.4{\%}). Short-term complications occurred in three of the 27 cases (11{\%}) (repeat hemorrhage, n = 2; common carotid artery occlusion, n = 1). The overall patient mortality rate was 36{\%} (nine of 25 patients, all with carotid blow-out syndrome). Six-month follow-up in 15 of the 16 living patients demonstrated widely patent stent-grafts. Two patients with pseudoaneurysm also demonstrated patent stents at 18- and 33-month follow-up. Conclusions: Stent-grafts may be useful in the treatment of carotid artery bleeding syndrome, aneurysm, and stenosis, with a high procedural success rate in selected cases. The results of mid-term follow-up are encouraging, but results of long-term follow-up must be evaluated in future studies.",
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