| Stent graft treatment of cerebrovascular wall defects: intermediate-term clinical and angiographic results. | |
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MedLine Citation:
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PMID: 18596518 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Endovascular stent graft (SG) deployment offers a useful vessel-preserving strategy for vascular wall lesions such as pseudoaneurysms and fistulae. Although deployment of expanded polytetrafluoro-ethylene-covered SGs within the carotid and vertebral arteries is technically feasible, data on long-term efficacy, safety, and patency rate remain sparse. METHODS: Six patients with traumatic (n = 4), iatrogenic (n = 1), or spontaneous (n = 1) internal carotid and vertebral artery injuries (direct carotid-cavernous fistula, n = 2; pseudoaneurysms, n = 4) were treated with nine balloon-mounted coronary expanded polytetrafluoro-ethylene SGs. Angiographic (mean, 2.3 yr; range, 1.7-4.2 yr) and neurological follow-up (mean, 2.7 yr) was performed for all patients. RESULTS: Complete angiographic exclusion of the lesion was achieved by the initial procedure in five of the six patients; one ruptured cavernous carotid aneurysm leading to a direct carotid-cavernous fistula showed persistent slow shunting despite tandem deployment of two SGs. All six patients revealed complete and persistent angiographic obliteration at delayed follow-up, with minimal in-stent stenosis (<20%) seen in two instances. Difficulty with SG navigation was encountered in five patients, resulting in one instance of guide catheter-induced intimal dissection. Type I endoleak was observed in five patients, requiring secondary angioplasty in four patients and deployment of an additional tandem SG in three. CONCLUSION: Technical challenges in current-generation SG deployment include sizing, navigation, positioning, and propensity for endoleak. When managed successfully, stent grafting provides a valuable approach for the treatment of vascular wall defects for which vessel preservation is preferred. Intermediate-term safety is satisfactory, with no delayed complications and minimal in-stent stenosis in follow-up periods of more than 2 years. |
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Authors:
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Daniel A Hoit; Clemens M Schirmer; Adel M Malek |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 62 ISSN: 1524-4040 ISO Abbreviation: Neurosurgery Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-07-03 Completed Date: 2008-10-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: ONS380-8; discussion ONS388-9 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Cerebrovascular and Endovascular Division, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Angiography Cerebral Angiography Cerebrovascular Disorders / radiography*, surgery* Equipment Failure Analysis Female Humans Male Middle Aged Neurosurgical Procedures / instrumentation* Pilot Projects Prosthesis Design Stents* Treatment Outcome Vascular Surgical Procedures / instrumentation* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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