Covered stent-graft repair of the brachiocephalic arteries: technical note.
OBJECTIVE
The use of a covered stent-graft to repair disruptions of the cervical carotid and vertebral arteries is described. This device maintains vessel patency while effectively excluding pseudoaneurysms, arteriovenous fistulae, and other breaches in the integrity of the arterial wall.


METHODS
Patient 1 bled from a large rent in the proximal common carotid artery as a result of tumor invasion. Patient 2 developed a vertebral arteriovenous fistula after a stab injury to the neck. Patient 3 developed cerebral infarction and an enlarging pseudoaneurysm of the internal carotid artery, also after a stab wound to the neck.


RESULTS
All three patients were treated with the Wallgraft endoprosthesis (Boston Scientific, Watertown, MA). In each case, the vessel wall defect was repaired while antegrade flow through the artery was preserved or restored. No neurological complications occurred as a result of stent-graft deployment.


CONCLUSIONS
Covered stent-grafts offer an alternative to endovascular occlusion of the parent vessel, thereby expanding the therapeutic options for patients with extracranial cerebrovascular disease. These three cases highlight the usefulness and versatility of these devices for endoluminal reconstruction of the brachiocephalic vasculature.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles 90033-1029, USA. amar@aya.yale.edu
Arun Paul
AP
Amar
George P
GP
Teitelbaum
Steven L
SL
Giannotta
Donald W
DW
Larsen
D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002533:Cerebral Angiography; D020099:Coated Materials, Biocompatible; D005260:Female; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D013382:Subtraction Technique; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
D020099:Coated Materials, Biocompatible