Department of Vascular Surgery, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Ji'nan, China.
Office of Healthcare-associated Infection Management, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Ji'nan, China.
Vascular. 2022 Feb;30(1):14-20. doi: 10.1177/1708538121990120. Epub 2021 Feb 17.
This study was aimed to evaluate the safety and efficacy of endovascular treatment of extracranial carotid artery aneurysms (ECAAs) using self-expandable covered stent grafts.
All patients with ECAA at a single institution were reviewed from February 2014 to February 2020. Eight consecutive patients (three men, mean age 64.5 years) treated with endovascular repair with self-expandable covered stent graft were retrospectively reviewed. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. Access to ECAA was gained via a femoral approach or a direct puncture of common carotid artery after surgical exposure because of kinking of the aortic arch and common carotid artery. A self-expandable covered stent graft (Viabahn; W. L. Gore, Flagstaff, AZ) was deployed to exclude the aneurysm.
Based on imaging features, there were five peudoaneurysms and three true aneurysms. The technical success rate was 100%. Cerebral protection devices were not used in all the patients during the procedures. Immediate absolute obliteration of the ECAA with no endoleak was documented in all the patients. Perioperative complications included one internal carotid-cavernous sinus fistula, one bleeding at the puncture site, and one stroke. The mean follow-up period was 35.5 months (range, 9-72 months). All the patients were alive, with an obligation rate of 100%. No transient ischemia attack, stroke, or reoccurrence of symptoms was identified during the follow-up period. Radiological examinations identified patency of the stent grafts and revealed no endoleaks, stent fracture, stent migration, or aneurysm rupture.
Endovascular treatment of ECAAs with self-expandable covered stent grafts appears to be a safe and feasible alternative for traditional open surgery, especially in the challenging anatomy and instable physical conditions. Although cerebrovascular accidents can occur as the result of hemodynamic changes during the perioperative period, the minimal alternative can yield satisfactory midterm follow-up clinical outcomes.
本研究旨在评估使用自膨式覆膜支架治疗颅外颈动脉瘤（ECAAs）的安全性和疗效。
回顾性分析 2014 年 2 月至 2020 年 2 月在单中心接受血管内治疗的 8 例连续 ECAAs 患者的资料，所有患者均采用自膨式覆膜支架进行血管内修复。回顾性记录患者特征、血管造影结果和随访结果。ECAAs 的入路通过股动脉或在主动脉弓和颈总动脉迂曲时直接穿刺颈总动脉获得。使用自膨式覆膜支架（Viabahn；戈尔公司，Flagstaff，AZ）来排除动脉瘤。
根据影像学特征，有 5 例假性动脉瘤和 3 例真性动脉瘤。技术成功率为 100%。所有患者在手术过程中均未使用脑保护装置。所有患者均即刻完全闭塞动脉瘤，无内漏。围手术期并发症包括 1 例颈内动脉-海绵窦瘘、1 例穿刺部位出血和 1 例中风。平均随访时间为 35.5 个月（9-72 个月）。所有患者均存活，生存率为 100%。随访期间无短暂性脑缺血发作、中风或症状复发。影像学检查发现支架通畅，无内漏、支架断裂、支架移位或动脉瘤破裂。
与传统的开放手术相比，自膨式覆膜支架治疗 ECAAs 似乎是一种安全可行的替代方法，尤其是在解剖结构复杂和患者身体状况不稳定的情况下。尽管围手术期可能会因血流动力学变化而导致脑血管意外，但这种微创治疗可以获得令人满意的中期随访临床结果。
