title: Jostent covered stent placement for emergency reconstruction of a ruptured internal carotid artery during or after transsphenoidal surgery.
abstract: OBJECTIVE
  Internal carotid artery (ICA) rupture during transsphenoidal surgery (TSS) is an extremely difficult complication to treat. This study aimed to evaluate the immediate and long-term outcomes of covered stent placement for emergency reconstruction of ruptured ICAs during or after TSS.
  
  
  METHODS
  Seven patients underwent covered stent placement for emergency reconstruction of a ruptured ICA during or after TSS. The safety and effectiveness of covered stent placement for emergency reconstruction of ruptured ICAs were retrospectively analyzed.
  
  
  RESULTS
  Pretreatment angiography showed active bleeding in 6 patients (5 intraoperative and 1 postoperative) and a pseudoaneurysm in 1 patient. Of the 6 patients with active bleeding, 5 were treated with a successive operation to control active bleeding. The other patient was treated just after cardiopulmonary resuscitation due to massive nasal bleeding 20 days after revision of TSS. All active bleeding was controlled immediately after covered stent insertion in these 6 patients. One patient showed a gap between the covered stent and ICA wall without active bleeding 30 minutes after glycoprotein IIb/IIIa inhibitor administration due to in-stent thrombosis. The gap was occluded with coil embolization after completion of the temporarily suspended TSS. The seventh patient, whose ICA tear was treated with surgical suture, underwent covered stent placement for a pseudoaneurysm detected on postoperative Day 2. During a mean follow-up period of 46 months (range 12-85 months), all patients had excellent outcomes (modified Rankin Scale score of 0). All the stented ICAs were patent on vascular imaging follow-up at a mean of 34 months (range 12-85 months).
  
  
  CONCLUSIONS
  Covered stents appear to be a safe and effective option for emergency reconstruction of ruptured ICAs during or after TSS.
authors.affiliation: Departments of 1 Radiology and.
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.forename: Pyoung
authors.initials: P
authors.lastname: Jeon
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.forename: Keun Young
authors.initials: KY
authors.lastname: Park
mesh_terms: D000328:Adult; D020212:Carotid Artery Injuries / Q000601:surgery*; D004638:Emergency Treatment; D004867:Equipment Design; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D012421:Rupture; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: CCF = carotid-cavernous fistula; ICA = internal carotid artery; MCA = middle cerebral artery; TSS = transsphenoidal surgery; covered stent; internal carotid artery; mRS = modified Rankin Scale; transsphenoidal surgery; vascular disorders