Endovascular treatment of extracranial carotid aneurysms
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1 Endovascular treatment of extracranial carotid aneurysms Poster No.: C-2028 Congress: ECR 2010 Type: Scientific Exhibit Topic: Interventional Radiology Authors: M. Szczerbo-Trojanowska, T. Jargie##o, M. J. Przyszlak; Lublin/ PL Keywords: extracranial aneurysm, embolization, endovascular treatment DOI: /ecr2010/C-2028 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8
2 Purpose Extracranial aneurysms of ICA are very rare, but surgery is extremely challenging due to anatomy of the region and technical limitations. Our goal is to demonstrate endovascular treatment options for extracranial ICA aneurysms and evaluate their usefulness based on treatment success rate and complications. Methods and Materials Since 1999 we've treated a group of 37 (20 female and 17 male) patients diagnosed with extracranial aneurysms (some with true aneurysms, some with pseudoaneurysms) of internal carotid artery. Based on etiology we divided them into 5 groups: arteriosclerotic (16 cases) post-traumatic (13 cases) dysplastic (4 cases) infectious (1 case) unknown (2 cases). Aneurysms ranged from 5mm to 56 mm in diameter with mean diameter of 28 mm. Our techniques involved: stent implantation (with both bare and covered stents) [Fig. 1] ICA trapping [Fig. 2] aneurysm coiling, remodeling, nbca embolisation [Fig. 3] Each procedure was performed after successful BTO. Images for this section: Page 2 of 8
3 Fig. 1 Page 3 of 8
4 Fig. 2 Page 4 of 8
5 Fig. 3 Page 5 of 8
6 Results Our complications consist of 2 TIA episodes after coiling, 1 major stroke (ipsilateral) after ICA embolization and 1 in-stent stenosis. There were no deaths and no aneurysmal ruptures. Endovascular treatment results show % success rate, 3-6,9% severe complications rate and below 1,5% in-stent stenosis. Conclusion Our experience with extracranial carotid aneurysms shows that endovascular treatment of those lesions is safe, efficient and therefore should be considered a primary treatment option. Good results depend heavily on proper choice of endovascular equipment and technique. BTO before each procedure is the best way to avoid unnecessary complications. On the other hand, it is important to remember that good BTO results cannot guarantee that complications will not occur. References 1. Schievink WI. The treatment of spontaneous carotid and vertebral artery dissections. Curr Opin Cardiol. 2000;15: Assali AR, Sdringola S, Moustapha A. Endovascular repair of traumatic pseudoaneurysm by uncovered self-expandable stenting with or without transstent coiling of the aneurysm cavity. Catheter Cardiovasc Interv. 2001;53: Bush RL, Lin PH, Dodson TF. et al. Endoluminal stent placement and coil embolization for the management of carotid artery pseudoaneurysms. J Endovasc Ther. 2001;8: Simionato F, Righi C, Melissano G. et al. Stent-graft treatment of a common carotid artery pseudoaneurysm. J Endovasc Ther. 2000;7: Page 6 of 8
7 5. Kubaska SM, Greenberg RK, Clair D. et al. Internal carotid artery pseudoaneurysms: treatment with the Wallgraft endoprosthesis. J Endovasc Ther. 2003;10: Wholey MH, Jarmolowski CR, Wholey M. et al. Carotid artery stent placement-ready for prime time?. J Vasc Interv Radiol. 2003;14: Becquemin JP, El Kadi HB, Desgranges P. et al. Carotid stenting versus carotid surgery: a prospective cohort study. J Endovasc Ther. 2003;10: Wholey MH, Al-Mubarek N, Wholey MH. Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv. 2003;60: Santoro A, Guidetti G, Dazzi M. et al. Long saphenous-vein grafts for extracranial and intracranial internal carotid aneurysms amenable neither to clipping nor to endovascular treatment. J Neurosurg Sci. 1999;43: Morgan M, Besser M, Dorsch N. et al. Treatment of intracranial aneurysms by combined proximal ligation and extracranial-intracranial bypass with vein graft. Surg Neurol. 1986;26: Coffin O, Maiza D, Galateau-Sallé F. Results of surgical management of internal carotid artery aneurysm by the cervical approach. Ann Vasc Surg. 1997;11: Christiansen S, Eiberg JP, Hansen MA. Common carotid artery pseudoaneurysm treated with a stent-graft. Eur J Vasc Endovasc Surg. 2002;24: Mukherjee D, Roffi M, Yadav JS. Endovascular treatment of carotid artery aneurysms with stent graft. J Invasive Cardiol. 2002;14: Scavee V, De Wispelaere JF, Mormont E. et al. Pseudoaneurysm of the internal carotid artery: treatment with a covered stent. Cardiovasc Intervent Radiol. 2001;24: Vos AWF, Linsen MAM, Marcus JT. et al. Carotid artery dynamics during head movements: a reason for concern with regard to carotid stenting?. J Endovasc Ther. 2003;10: Page 7 of 8
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