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2.
Eur J Vasc Endovasc Surg ; 60(3): 347-354, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32631711

RESUMO

OBJECTIVE: The objective of this study was to evaluate the outcomes of open surgery (OS) and endovascular surgery (ES) for extracranial carotid aneurysm (ECCA) in the authors' centre. METHODS: Fifty-seven consecutive patients who were diagnosed with ECCA and underwent intervention from January 2005 to July 2019 at Zhongshan Hospital, Fudan University, were reviewed retrospectively. Patient characteristics and surgical outcomes for OS and ES were analysed. ECCAs were divided into three morphological subgroups: subgroup Ⅰ, no severe tortuosity of the internal carotid artery (ICA) or common carotid artery (CCA) proximal to the aneurysm, tortuosity of the aneurysm and 1 cm of peri-aneurysmal carotid artery ≤ 90°; subgroup Ⅱ, severe ICA or CCA tortuosity proximal to the aneurysm, tortuosity of the aneurysm and 1 cm of peri-aneurysmal carotid artery ≤ 90°; subgroup Ⅲ, aneurysm tortuosity and 1 cm peri-aneurysmal carotid artery > 90°. RESULTS: 35 patients underwent OS, 20 patients underwent ES and 2 patients underwent OS after the failure of ES. Thirty-six cases were classified in subgroup Ⅰ, 11 cases in subgroup Ⅱ, and 10 cases in subgroup Ⅲ. ES was achieved successfully in all 18 cases of subgroup I, but failed in three of four cases in subgroups Ⅱ and Ⅲ. With a mean duration of 62.9 ± 44.5 months of follow up, five deaths were recorded in the OS group, two of which were caused by ipsilateral stroke and three were not neurologically related. There was no stroke or death in the ES group during follow up. One case of stroke and two cases of death occurred in symptomatic patients, while one case of stroke and three cases of death occurred in asymptomatic patients. CONCLUSION: This series demonstrates that ES may be a safe and durable option for ECCA in subgroup Ⅰ, while in subgroups Ⅱ and Ⅲ, ES alone may be difficult to apply. A 30 day stroke rate around 5% existed in ECCAs with interventions, which should be considered before the intervention.


Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Procedimentos Endovasculares , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Anastomose Cirúrgica , Aneurisma/diagnóstico por imagem , Aneurisma/mortalidade , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/mortalidade , China , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
3.
Asian Cardiovasc Thorac Ann ; 28(5): 279-281, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32483974

RESUMO

Mycobacterium tuberculosis is a very rare cause of extracranial carotid artery pseudoaneurysm. A 39-year-old man presented with a rapidly increasing neck mass and hoarseness of voice for 15 days. He was on antitubercular treatment for pulmonary tuberculosis. Computed tomography angiography showed a large pseudoaneurysm of the right common carotid artery. Emergency surgery was performed to excise the pseudoaneurysm sac and repair the artery with a Dacron graft. Postoperative angiography showed normal flow in the carotids and cerebral circulation. Histology of the excised tissue was consistent with a tubercular etiology of the pseudoaneurysm.


Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Doenças das Artérias Carótidas/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antituberculosos/uso terapêutico , Implante de Prótese Vascular , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Humanos , Masculino , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico
4.
Vasc Endovascular Surg ; 54(6): 549-552, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32468915

RESUMO

We describe a 54-year-old man with neurofibromatosis type 1 who presented with a left-sided neck mass. Computed tomography demonstrated a left common carotid artery aneurysm (51 × 33 mm). Surgery was performed because of the risk of rupture. The left common carotid artery was found to be a huge aneurysmal dilatation, and the arterial wall partially collapsed and extensively adherent to the surrounding tissues. Left common carotid artery to internal carotid artery bypass grafting was performed with a reversed saphenous vein graft. Histopathological examination revealed vascular fragility of the left carotid arterial wall.


Assuntos
Falso Aneurisma/etiologia , Doenças das Artérias Carótidas/etiologia , Artéria Carótida Primitiva , Neurofibromatose 1/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibromatose 1/diagnóstico por imagem , Veia Safena/transplante , Resultado do Tratamento
5.
World Neurosurg ; 139: 419-422, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360918

RESUMO

OBJECTIVE: To describe a case of an adult female Filipino with hypereosinophilia and bilateral carotid artery aneurysms who subsequently developed bilateral cerebral hemisphere strokes following aneurysm stenting. CASE DESCRIPTION: A 57-year-old female patient with persistent hypereosinophilia presented with progressively enlarging bilateral neck masses, revealed to be carotid artery aneurysms on computed tomography angiography. Following surgical exploration, she later developed right-sided hemiplegia, aphasia, and right hemianopia. Cranial computed tomography revealed infarcts on both middle cerebral artery territories. Bone marrow biopsy and fluorescent in situ hybridization revealed findings suggestive of hypereosinophilic syndrome. She was started on standard aspirin and statin therapy and was discharged sixteen days after the procedure. Partial improvement of neurologic deficits was noted two months later on follow up. Chemotherapy with imatinib was initiated. CONCLUSIONS: This patient's prothrombotic state from FIP1L1-PDGFRA-positive hypereosinophilia may have led to large carotid artery aneurysm formation and intramural thrombosis. This case demonstrates a possible and heretofore undocumented neurovascular sequela of hypereosinophilic syndrome.


Assuntos
Aneurisma/complicações , Procedimentos Endovasculares/efeitos adversos , Síndrome Hipereosinofílica/complicações , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/etiologia , Aneurisma/cirurgia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Feminino , Humanos , Síndrome Hipereosinofílica/genética , Pessoa de Meia-Idade , Proteínas de Fusão Oncogênica , Receptor alfa de Fator de Crescimento Derivado de Plaquetas , Stents , Fatores de Poliadenilação e Clivagem de mRNA
7.
Vasc Endovascular Surg ; 54(4): 378-381, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32270756

RESUMO

Extracranial internal carotid artery (ICA) aneurysms account for <1.0% all aneurysms and a rare indication for carotid intervention. Causes include atherosclerotic degeneration, trauma, dissection, previous carotid surgery, connective tissue disorders, and infection. Authors report a case of a middle-aged male found to have a large aneurysm of the left ICA who underwent repair by resection and reconstruction with end-to-end anastomosis under neuroprotection with flow reversal. Our discussion includes a recommendation for this particular surgical repair. The patient in this case report has granted the authors consent for review of records and subsequent publication submission.


Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Dispositivos de Proteção Embólica , Procedimentos Cirúrgicos Vasculares/instrumentação , Anastomose Cirúrgica , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Circulação Cerebrovascular , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
PLoS One ; 15(4): e0231261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275700

RESUMO

PURPOSE: Patient-reported long-term follow-up after endovascular treatment of indirect carotid cavernous fistulas is important, but rarely addressed in literature. We report on this issue with a special focus on the patient's view and its impact on the indication evaluation process. METHODS: We retrospectively reviewed the records of all patients (n = 33) with a minimum follow-up interval of at least 36 and up to 166 months after endovascular treatment of an indirect carotid cavernous fistula (Barrow B-D) at our institution (treated from 01/2003 to 06/2015). We determined treatment details including primary therapy success and complication rate and quote the patient's subjective perception of the long-term treatment success using a standardized interview form. RESULTS: As a primary result the fistula was completely occluded in 25/33 cases (76%), while a downgrading was achieved in 8/33 (24%) of the cases. Secondary occlusion was observed in three out of eight patients (38%). In the long-term interview (response rate: 91%, median follow-up interval: 114 months) 87% of the patients reported high satisfaction with the long-term therapy result. Endovascular treatment achieved a sustainable relief from all eye-related symptoms in 89% and from pulsatile tinnitus in 57% of the cases. CONCLUSIONS: In addition to good results in terms of angiographic and clinical cure, endovascular treatment is also perceived as beneficial by most of the patients. This is another important argument in favor of an endovascular treatment.


Assuntos
Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Procedimentos Endovasculares , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual , Adulto Jovem
9.
Vasc Med ; 25(4): 328-333, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32303154

RESUMO

The objective of this study was to investigate the correlation between the amount of blood flow in the area of neovascularization within a carotid atherosclerotic plaque by superb microvascular imaging (SMI) and the microvessel density (MVD) determined by histopathological staining. Twenty-eight carotid atherosclerotic plaques were detected by SMI in 28 patients who underwent carotid endarterectomy. SMI was graded according to the visual methods as follows: grade I: no appearance of neovascularization within the plaque; grade II: punctate neovascularization; grade III: one or two linear neovascularizations within the plaque; and grade IV: multiple (> 2) linear neovascularizations throughout the plaque. The neovascularization density was determined by the CD31 complex staining method. There was a significant correlation between the density of neovascularization in histopathologic plaques and the blood flow grade found by SMI (r = 0.788, p < 0.001). A significant difference was observed in SMI blood flow grade between the symptomatic and asymptomatic groups (χ2 = 2.634, p = 0.036). The MVD of plaques in the symptomatic group was significantly higher than that in the asymptomatic group (t = 2.530, p = 0.018). The SMI-based classification was positively correlated with plaque thickness. SMI, which is a new nonultrasound contrast-enhanced imaging method, can effectively evaluate neovascularization in carotid atherosclerotic plaques and can be used as a novel method for the clinical prediction of stroke risk.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Microvasos/diagnóstico por imagem , Neovascularização Patológica , Placa Aterosclerótica , Ultrassonografia , Idoso , Velocidade do Fluxo Sanguíneo , Artérias Carótidas/patologia , Artérias Carótidas/fisiopatologia , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/cirurgia , Endarterectomia das Carótidas , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Microcirculação , Microvasos/patologia , Microvasos/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes
10.
Stroke ; 51(5): 1539-1545, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32268851

RESUMO

Background and Purpose- We aimed to compare functional and procedural outcomes of patients with acute ischemic stroke with none-to-minimal (modified Rankin Scale [mRS] score, 0-1) and moderate (mRS score, 2-3) prestroke disability treated with mechanical thrombectomy. Methods- Consecutive adult patients undergoing mechanical thrombectomy for an anterior circulation stroke were prospectively identified at 2 comprehensive stroke centers from 2012 to 2018. Procedural and 90-day functional outcomes were compared among patients with prestroke mRS scores 0 to 1 and 2 to 3 using χ2, logistic, and linear regression tests. Primary outcome and significant differences in secondary outcomes were adjusted for prespecified covariates. Results- Of 919 patients treated with mechanical thrombectomy, 761 were included and 259 (34%) patients had moderate prestroke disability. Ninety-day mRS score 0 to 1 or no worsening of prestroke mRS was observed in 36.7% and 26.7% of patients with no-to-minimal and moderate prestroke disability, respectively (odds ratio, 0.63 [0.45-0.88], P=0.008; adjusted odds ratio, 0.90 [0.60-1.35], P=0.6). No increase in the disability at 90 days was observed in 22.4% and 26.7%, respectively. Rate of symptomatic intracerebral hemorrhage (7.3% versus 6.2%, P=0.65), successful recanalization (86.7% versus 83.8%, P=0.33), and median length of hospital stay (5 versus 5 days, P=0.06) were not significantly different. Death by 90 days was higher in patients with moderate prestroke disability (14.3% versus 40.3%; odds ratio, 4.06 [2.82-5.86], P<0.001; adjusted odds ratio, 2.83 [1.84, 4.37], P<0.001). Conclusions- One-third of patients undergoing mechanical thrombectomy had a moderate prestroke disability. There was insufficient evidence that functional and procedural outcomes were different between patients with no-to-minimal and moderate prestroke disability. Patients with prestroke disability were more likely to die by 90 days.


Assuntos
Atividades Cotidianas , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Pessoas com Deficiência , Infarto da Artéria Cerebral Média/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral , Comorbidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Prospectivos , Acidente Vascular Cerebral/cirurgia , Terapia Trombolítica/métodos , Resultado do Tratamento
11.
J Neurointerv Surg ; 12(4): 345-349, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115436

RESUMO

BACKGROUND: Robots in surgery aid in performing delicate, precise maneuvers that humans, with inherent physical abilities, may be limited to perform. The CorPath 200 system is FDA approved and is being implemented in the US for interventional cardiology procedures. CorPath GRX robotic-assisted platform is the next-generation successor of CorPath 200. OBJECTIVE: To discuss the feasibility and early experience with the use of the CorPath GRX robotic-assisted platform for neuroendovascular procedures, including transradial diagnostic cerebral angiograms and transradial carotid artery stenting. METHODS: The cases of 10 consecutive patients who underwent neuroendovascular robotic-assisted procedures between December 1, 2019 and December 30, 2019, are presented. RESULTS: Seven patients underwent elective diagnostic cerebral angiography, and three patients underwent carotid artery angioplasty and stenting using the CorPath GRX robotic-assisted platform. All procedures were performed successfully, and no complications were encountered. Conversion to manual control occurred in three diagnostic cases because of a bovine arch that was previously not known. The fluoroscopy time and the procedure time continued to improve with subsequent procedures as we streamlined the workflow. CONCLUSION: This series demonstrates the early use of this technology. It could potentially be used in the near future for acute stroke interventions in remote geographic locations and in places where a neurointerventionalist is not available.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Angiografia Cerebral/métodos , Procedimentos Endovasculares/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Angiografia Cerebral/instrumentação , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/instrumentação , Stents , Resultado do Tratamento
12.
World Neurosurg ; 138: 7-8, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112933

RESUMO

BACKGROUND: Surgical treatment for symptomatic extracranial carotid artery aneurysms should be encouraged because of their high recurrence rates. CASE DESCRIPTION: A 55-year-old man presented with progressive right-sided hemiparesis and dysarthria. Computed tomography angiography revealed the cause of his repeated cerebral infarction was due to the distal emboli from an intra-aneurysmal thrombus of a giant thrombosed aneurysm at the origin of left common carotid artery. Right common carotid artery-saphenous vein graft-left common carotid artery bypass followed by left common carotid artery ligation was successfully performed. CONCLUSIONS: Carotid-carotid bypass followed by common carotid artery ligation is an optional procedure for symptomatic proximal common carotid artery aneurysm.


Assuntos
Anastomose Cirúrgica/métodos , Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Aneurisma/complicações , Doenças das Artérias Carótidas/complicações , Artéria Carótida Externa/cirurgia , Infarto Cerebral/etiologia , Humanos , Embolia Intracraniana/etiologia , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Veia Safena/cirurgia
13.
Stroke ; 51(5): 1522-1529, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32188367

RESUMO

Background and Purpose- Antiplatelet agents could be used in the setting of endovascular therapy for tandem occlusions to reduce the risk of de novo intracranial embolic migration, reocclusion of the extracranial internal carotid artery lesion, or in-stent thrombosis in case of carotid stent placement but have to be balanced with the intracerebral hemorrhagic transformation risk. In this study, we aim to investigate the impact of acute antiplatelet therapy administration on outcomes during endovascular therapy for anterior circulation tandem occlusions. Methods- This is a retrospective analysis of a collaborative pooled analysis of 11 prospective databases from the multicenter observational TITAN registry (Thrombectomy in Tandem Lesions). Patients were divided into groups based on the number of antiplatelet administered during endovascular therapy. The primary outcome was favorable outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days. Results- This study included a total of 369 patients; 145 (39.3%) did not receive any antiplatelet agent and 224 (60.7%) received at least 1 antiplatelet agent during the procedure. Rate of favorable outcome was nonsignificantly higher in patients treated with antiplatelet therapy (58.3%) compared with those treated without antiplatelet (46.0%; adjusted odds ratio, 1.38 [95% CI, 0.78-2.43]; P=0.26). Rate of 90-day mortality was significantly lower in patients treated with antiplatelet therapy (11.2% versus 18.7%; adjusted odds ratio, 0.47 [95% CI, 0.22-0.98]; P=0.042), without increasing the risk of any intracerebral hemorrhage. Successful reperfusion (modified Thrombolysis in Cerebral Ischemia score 2b-3) rate was significantly better in the antiplatelet therapy group (83.9% versus 71.0%; adjusted odds ratio, 1.89 [95% CI, 1.01-3.64]; P=0.045). Conclusions- Administration of antiplatelet therapy during endovascular therapy for anterior circulation tandem occlusions was safe and was associated with a lower 90-day mortality. Optimal antiplatelet therapy remains to be assessed, especially when emergent carotid artery stenting is performed. Further randomized controlled trials are needed.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Infarto da Artéria Cerebral Média/cirurgia , Cuidados Intraoperatórios/métodos , Inibidores da Agregação de Plaquetas/uso terapêutico , Trombectomia/métodos , Idoso , Doenças das Artérias Carótidas/complicações , Artéria Carótida Interna/cirurgia , Hemorragia Cerebral/epidemiologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Masculino , Pessoa de Meia-Idade , Mortalidade , Recidiva , Sistema de Registros , Estudos Retrospectivos , Stents , Trombose/prevenção & controle , Resultado do Tratamento
15.
World Neurosurg ; 136: e567-e577, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31958590

RESUMO

OBJECTIVE: Ruptured blister aneurysms of the internal carotid artery are challenging to treat because of their difficult diagnosis and the fragility of the wall structure. Here, we sought to clarify the efficacy of extracranial-intracranial bypass followed by trapping (bypass/trapping) for ruptured blister aneurysms. METHODS: A retrospective study identified 45 patients with ruptured blister aneurysms between 1998 and 2017. Our principle was to attempt bypass/trapping as early as possible after diagnosis (early surgery). If early diagnosis was difficult, patients underwent elective surgery in the later stage when aneurysms were detected (elective surgery). Patient characteristics, radiologic findings, clinical course, and outcomes were analyzed. RESULTS: Forty-three patients were treated by bypass/trapping. Twenty-eight patients were classified as early surgery and 15 as elective surgery. Two patients experienced fatal rebleeding and did not undergo surgery. All 15 patients in the elective surgery group showed rebleeding and/or aneurysmal growth while awaiting surgery. In the elective surgery group, 10 aneurysms were missed initially by catheter angiography. In the early surgery group, 9 patients were assessed by vessel wall magnetic resonance imaging, which showed circumferential enhancement along the aneurysm wall, most of which was shown as only a small bulge in the angiography. Postoperative rebleeding did not occur in any of the patients. CONCLUSIONS: Bypass/trapping is effective to prevent rebleeding. Early surgery may be beneficial, because most patients in the elective surgery group showed rebleeding or aneurysmal growth. Vessel wall magnetic resonance imaging is a useful adjunct for early diagnosis and may contribute to prompt early surgery.


Assuntos
Aneurisma Roto/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Adulto Jovem
16.
Ann Vasc Surg ; 66: 669.e17-669.e20, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31978486

RESUMO

BACKGROUND: Extracranial carotid artery aneurysm is an extremely rare peripheral arterial aneurysm. The treatments of extracranial CAAs include open surgical, endovascular, and conservative options. Main surgical indications are transient ischemia attacks, strokes, or progressive growth. But both open surgery and endovascular repair have disadvantages and complications. METHODS: We report a case of true internal carotid artery aneurysm (ICAA) with hostile anatomic conditions for both open surgery and endovascular approach in a 53-year-old man who presented with new cerebral infarctions. According to the features of this case, the patient was treated with a new hybrid procedure with extra-luminal aneurysm repair. A sheath was inserted through the common carotid artery, maneuvered out of the lumen through the proximal landing zone of the ICAA, and then returned into the distal normal vessel of the internal carotid artery. A stent graft was delivered through the sheath and was deployed while retrieving the sheath. RESULTS: The aneurysm was repaired successfully with an uneventful postoperative course and no postprocedural complications. The patient has been followed up for 2 years with no symptom, and the stent was patent without restenosis. CONCLUSIONS: The procedure is feasible and provides a new solution for difficult cases like this.


Assuntos
Aneurisma/cirurgia , Angioplastia com Balão , Implante de Prótese Vascular , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Angioplastia com Balão/instrumentação , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Stents , Resultado do Tratamento
18.
J Neurointerv Surg ; 12(1): 33-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31308199

RESUMO

PURPOSE: To evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent. METHODS: Multicenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries. RESULTS: Overall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9-18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), respectively, this occurred during the procedure. No statistically significant difference was observed between patients with and without thrombus formation with regard to pre-existing long term medication with anticoagulants or intraprocedural administration of heparin, acetylsalicylic acid (ASA), or heparin and ASA. Favorable early neurological outcome was similar in patients with (n=15; 45.5%) and without (n=63; 49.6%) thrombus formation at the CASPER stent. CONCLUSION: Acute thrombosis or occlusion of CASPER stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions were observed more often during the procedure than within 72 hours of follow-up, were less frequent then previously reported, and showed no impact on early neurological outcome.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Procedimentos Endovasculares/efeitos adversos , Stents/efeitos adversos , Trombose/etiologia , Idoso , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/epidemiologia , Procedimentos Endovasculares/instrumentação , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Resultado do Tratamento
20.
World Neurosurg ; 134: e153-e161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629143

RESUMO

OBJECTIVE: Clipping of paraclinoid aneurysm is still challenging because of poor visual morbidity. The extradural temporopolar approach was applied to clip paraclinoid aneurysms, with the expectation of reducing visual morbidity. Factors related to poor visual morbidity were evaluated, to assess the results for clipping of paraclinoid aneurysms. METHODS: A series of 40 unruptured paraclinoid aneurysms in 38 patients were clipped via extradural temporopolar approach. Preoperative and postoperative states of visual cognitive function and radiological outcomes were investigated. Aneurysms were classified into dorsal type or non-dorsal type, and small (<9 mm) or not-small (≥9 mm), respectively, to identify factors correlated with visual morbidity. RESULTS: Complete clipping rate was 90.0% without any recurrence (mean: 5.2 years). Visual morbidity was unexpectedly high at 28.9%, including 2.7% of blindness immediately after the operation, and 23.7% and 2.7% at the final examination (mean: 3.6 years). Multivariate analysis showed aneurysm size was significantly correlated with worse visual outcome. Visual morbidity was 13.3% and 11.1% for dorsal and the non-dorsal small aneurysms, respectively, and all these cases showed visual field defect limited to the nasal quadrant without decreased visual acuity. In contrast, the non-dorsal not-small aneurysms showed significantly worse visual morbidity (60%) with decreased visual acuity. CONCLUSIONS: Clipping via extradural temporopolar approach can achieve durable treatment for small unruptured paraclinoid aneurysms with acceptable visual morbidity. Visual morbidity of the not-small non-dorsal type, however, was poor. The indications for clipping of paraclinoid aneurysm should be limited to small aneurysms, especially the dorsal type in young patients.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Aneurisma Intracraniano/cirurgia , Instrumentos Cirúrgicos , Adulto , Idoso , Angiografia Cerebral/efeitos adversos , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Morbidade , Procedimentos Neurocirúrgicos/efeitos adversos , Instrumentos Cirúrgicos/efeitos adversos , Tempo , Resultado do Tratamento
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