Zaidi S Taha, George Mitchell J, Cambiaghi Tommaso, Saqib Naveed, Miles Daniel, Wang Shihuan, Harlin Stuart
Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
J Vasc Surg Cases Innov Tech. 2023 Oct 10;9(4):101347. doi: 10.1016/j.jvscit.2023.101347. eCollection 2023 Dec.
An extracranial carotid artery aneurysm (ECAA) is a rare pathology comprising <1% of all arterial aneurysms. The etiology includes trauma, previous surgery, radiation, and infection. Treatment of ECAAs has evolved from open repair to endovascular repair with stenting. Reports of endovascular repair describe the transfemoral approach; however, little more than case reports are available describing the transcarotid approach for ECAAs. In this study, we describe a cohort of patients who safely underwent transcarotid repair of ECAAs.
We performed a retrospective medical record review of all cases of transcarotid stenting using covered stents for a carotid aneurysm within 11 different hospitals within the Memorial Hermann Health System from December 2019 through December 2022. Technical success is defined as coverage of the aneurysm with no endoleak. We report the patient demographics, clinical presentation, intraoperative metrics, and outcomes.
Seven patients underwent transcarotid covered stent placement using flow reversal for neurologic protection. Their average age was 65 years, and four of the seven patients were men. Three patients presented with pain, two with transient ischemic attack, one with stroke, and one with a pulsatile mass. Technical success was 100%. All the patients were treated with transcarotid stenting, and the average aneurysm size was 13 mm. The average operative time was 69 minutes, and the flow reversal time was 9 minutes. No postoperative stroke, myocardial infarction, or death occurred. The average length of hospital stay was 2.7 days.
A transcarotid approach for endovascular treatment of ECAAs was safe for this cohort of patients, with no postoperative death, stroke, or myocardial infarction. Also, the technical success was 100%.
颅外颈动脉动脉瘤（ECAA）是一种罕见的病变，在所有动脉动脉瘤中占比不到1%。其病因包括创伤、既往手术、放疗和感染。ECAA的治疗已从开放修复发展到带支架的血管内修复。血管内修复的报告描述了经股动脉入路；然而，关于ECAA经颈动脉入路的描述，除了病例报告外几乎没有更多内容。在本研究中，我们描述了一组安全接受ECAA经颈动脉修复的患者。
我们对2019年12月至2022年12月期间在纪念赫尔曼医疗系统内11家不同医院使用覆膜支架经颈动脉支架置入治疗颈动脉动脉瘤的所有病例进行了回顾性病历审查。技术成功定义为动脉瘤得到覆盖且无内漏。我们报告患者的人口统计学特征、临床表现、术中指标和结果。
7例患者采用血流逆转技术经颈动脉置入覆膜支架以保护神经功能。他们的平均年龄为65岁，7例患者中有4例为男性。3例患者表现为疼痛，2例表现为短暂性脑缺血发作，1例表现为中风，1例表现为搏动性肿块。技术成功率为100%。所有患者均接受了经颈动脉支架置入治疗，动脉瘤平均大小为13毫米。平均手术时间为69分钟，血流逆转时间为9分钟。术后未发生中风、心肌梗死或死亡。平均住院时间为2.7天。
对于该组患者，经颈动脉入路血管内治疗ECAA是安全的，术后无死亡、中风或心肌梗死发生。此外，技术成功率为100%。
