Our experience with graft stents in the treatment of diseases of the main arteries of the brain
Objective – to study the efficacy and safety of stent grafts in the treatment of diseases of the cerebral arteries.
Materials and methods. It was analysed results of treatment of 6 patients (3 men and 3 women) with disease of the main arteries of the brain, where stent graft was used. The youngest patient was 35 years old, the oldest was 60. Results were evaluated by data of somatic and neurological examination, selective cerebral angiography, computer and magnetic resonance imaging. Surgery performed within 1 to 3 months from the onset of the disease. On a modified Rankin scale four patients have 0 point, two have 1 point. All patients received double disaggregant therapy, clopidogrel 75 mg, and aspirin 100 mg per day before the intervention. Sensitivity to clopidogrel was determined by the method of light transmission aggregate. All interventions were performed under general anesthesia; the duration of the intervention ranged from 25 to 90 minutes, average mean was 45 minutes. Used for stent surgery Atrium Advanta V12 and Graftmaster.
Results. In four cases, stent implantation had no technical difficulties. In two cases, technical difficulties arose due to the structural features of the stent system, in particular, the rigid system distal to the stent itself, which limits the stent navigation in curved areas. In one case, due to the use of rigid delivery system and implantation of the stent by the method of retrograde opening from the guide catheter was able to implant at the level of the aneurysm. In one case, the stent was implanted without covering the distal part of the artery, after stent implantation a stasis of contrast fluid in the aneurysm cavity was noted. Control angiography after 6 months to demonstrate total exclusion of an aneurysm from the bloodstream. Using the features of the stent, it was possible to separate the arteriovenous complicity between the vertebral artery and the paravertebral venous plexus with complete reconstruction of the artery. There were no intraoperative and postoperative complications. Duration of stay of patients in hospital 3–5 days. In all cases, reconstruction of the artery was achieved with the exception of an aneurysm from the bloodstream or disconnection of the arteriovenous shunt.
Conclusions. The preliminary accumulated results of the use of stent grafts in the aneurysms of the extracranial carotid section indicate that this technique has advantages over “conservative surgical treatment” by reducing surgical trauma, no risk of damage to the cranial nerves, shorter stay time. In case of erosive bleeding and arteriovenous joints, the use of stent graft should be considered as a method of choice.
Shlomin VV, Kasjanov IV, Drozhzhzhin IG i dr. Hirurgicheskoe lechenie tromboza jendoproteza brjushnoj aorty. Angiologija i sosudistaja hirurgija. 2018;2:184-8. (in Russian)
Donas KP, Schulte S, Pitoulias GA et al. Surgical outcome of degenerative versus post reconstructive extracranial carotid artery aneurysms. J Vasc Surg. 2009;49(1):93-8. doi:10.1016/j.jvs.2008.08.006.
Zhou W, Lin PH, Bush RL et al. Carotid artery aneurysm: evolution of management over two decades. J Vasc Surg. 2006;43(3):493-6. doi:10.1016/j.jvs.2005.11.023
Welleweerd JC, Moll FL, de Borst GJ. Technical options for the treatment of extracranial carotid aneurysms. Expert Rev Cardiovasc Ther. 2012;10(7):925-31. doi:10.1586/erc.12.61.
Bravo Ruiz E, Suarez Tornín MJ, Salazar Agorria A, et al. Transient ischaemic attack secondary to extracranial carotid artery aneurysm. Neurologia. 2014;29(8):505-7. doi:10.1016/j.nrl.2013.06.005. Epub 2013 Aug 20.
Attigah N, Külkens S, Zausig N et al. Surgical therapy of extracranial carotid artery aneurysms: long-term results over a 24-year period. Eur J Vasc Endovasc Surg. 2009;37:127-33. doi:https://doi.org/10.1016/j.jvs.2008.12.056
Seward CJ, Dumont TM, Levy EI. Endovascular therapy of extracranial carotid artery pseudoaneurysms: case series and literature review. J Neurointerv Surg. 2015;7:682-9. doi:10.1136/neurintsurg-2014-011252
Li Z, Chang G, Yao C et al. Endovascular stenting of extracranial carotid artery aneurysm: a systematic review. Eur J Vasc Endovasc Surg. 2011;42(4):419-26. doi:10.1016/j.ejvs.2011.05.008. Epub 2011 Jun 8.
This work is licensed under a Creative Commons Attribution 4.0 International License.