Stent-grafts in the treatment of emergent or urgent carotid artery disease: review of 25 cases.
OBJECTIVE
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.


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.
Hoppe
Hanno
H
Dotter Interventional Institute, Oregon Health and Sciences University, Portland, OR 97201, USA.
Barnwell
Stanley L
SL
Nesbit
Gary M
GM
Petersen
Bryan D
BD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000503:physiopathology / Q000601:surgery; D017541:Aneurysm, False / Q000503:physiopathology / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery; D004617:Embolism / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control* / Q000601:surgery; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D012421:Rupture; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000503:physiopathology / Q000601:surgery; D014654:Vascular Patency
D011138:Polytetrafluoroethylene