Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To evaluate the prognosis of interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma by single-arm meta-analysis. Methods    Related studies on treating retrograde Stanford type A aortic dissection and intramural hematoma with covered stent graft were retrieved from the databases by computer, including PubMed, EMbase, The Cochrane Library, Wanfang Data, VIP, CNKI and CBM, from inception to January 2020. Literatures were screened by researchers step by step according to the predefined inclusion and exclusion criteria. Quality of the enrolled literatures was evaluated, and data were extracted from the included studies. Afterwards, single-arm meta-analysis was carried out by the R3.6.3 software. Results    A total of 12 English and 5 Chinese studies were included, which were all case series, and the quality of all literatures was moderate evaluated by Newcastle-Ottawa Scale (NOS). After analyzing the clinical prognosis of 260 patients, the 30-day mortality was 6% (95%CI 0.04 to 0.11, P=0.97), the late mortality was 8% (95%CI 0.05 to 0.14, P=0.78), the incidence of endoleak was 21% (95%CI 0.16 to 0.29, P=0.06), the incidence of stroke was 5% (95%CI 0.03 to 0.09, P=0.99), the incidence of new aortic dissection was 7% (95%CI 0.04 to 0.11, P=0.96), the incidence of dissection progression was 10% (95%CI 0.07 to 0.16, P=0.24), and the absorption rate of intramural hematoma was 84% (95%CI 0.37 to 1.00, P<0.01). Conclusion    Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma can obtain good early treatment results for some patients, and can be used as a safe and effective treatment for aged patient with high risk who cannot tolerate surgery. Endoleak, stroke and new aortic dissection are the early serious complications of this method.

Application of covered stent in treatment of carotid blowout after head and neck tumors resection / 中国耳鼻咽喉头颈外科

OBJECTIVE To assess the treatment reliability of covered stent for carotid artery blowout after head and neck tumors resection. METHODS Five cases with postoperative rupture of carotid artery invaded by the head and neck tumor were reviewed. They presented with life threatening massive neck or oral bleedings. All of them were treated with self expanding covered stents through intervention therapy approach. RESULTS The covered stent were successfully deployed in the target arteries in all cases,the instant isolation effect was quite satisfactory. After treatment, angiography showed successful occlusion of the pseudoaneurysm, patency of carotid artery lumen, and significant improvement of clinical symptoms without neurologic dysfunction. Following up 2 to 36 months, 3 patients were alive with no disease, two patients died of recurrence. CONCLUSION For the treatment of carotid blowout, endovascular occlusion with covered stent is a minimally-invasive, safe and reliable methods.

Preoperational application of dual-source CT in assessment of three branches aortic arch covered stent graft implantation(preoperational evaluation for DeBakey type Ⅰ aortic dissection) / 实用放射学杂志

Objective To estimate the application value of dual-source CT on preoperational evaluating new type of three branches aortic arch covered stent graft implantation on DeBakey type I aortic dissection.Methods 20 cases with DeBakey type I aortic dissec-tion prepared to performe three branches aortic arch covered stent graft implantation were reviewed,and their CT findings were ana-lyzed in order to evaluate the guiding value for operation.Results The location and size of entries were determined and the diameter of aortic arch and three branchesas well as the intervals of three branches were also measured by dual-source CT.Furthermore, blood-supply for main vessel and complications related with covered stent were further analyzed prior to operation.The surgical pro-tocols were designed according to preoperational CT findings.Among all cases,13 cases were fit for new type of three branches aor-tic arch covered stent graft implantation.While the rest cases (N=7)were adopted other operations due to non-fitted indications. Conclusion Dual-source CT is of significance for preoperational evaluating new type of three branches aortic arch covered stent graft implantation on DeBakey type I aortic dissection.

Endovascular treatment of iatrogenic penetrating trauma of the carotid artery: case report / Tratamento endovascular de trauma penetrante iatrogênico de artéria carótida: relato de caso

Carotid trauma demands early diagnosis and treatment. Open repair may be technically challenging if the trauma is at the base of the neck. We present a case of iatrogenic penetrating carotid trauma caused by insertion of a hemodialysis catheter. Treatment was accomplished by placement of a covered stent-graft in the common carotid artery, covering the puncture site. This case suggests that placement of a covered stent-graft is a good option for treatment of iatrogenic injury to the carotid artery...

O trauma da carótida exige diagnóstico e tratamento precoces. O tratamento convencional pode ser tecnicamente desafiador se o trauma penetrante for na base do pescoço. Apresentamos um caso de trauma penetrante da carótida associado ao implante iatrogênico de um cateter para hemodiálise. O tratamento foi realizado através da colocação de uma endoprótese na artéria carótida comum, cobrindo o local da punção. Este caso sugere que a colocação de uma endoprótese é uma boa opção para o tratamento de lesão iatrogênica da artéria carótida...

Bilateral Vertebral Artery Dissecting Aneurysms Presenting with Subarachnoid Hemorrhage Treated by Staged Coil Trapping and Covered Stents Graft

The treatment of bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid hemorrhage (SAH) is still challenging. The authors report a rare case of bilateral VADA treated with coil trapping of ruptured VADA and covered stents implantation after multiple unsuccessful stent assisted coiling of the contralateral unruptured VADA. A 44-year-old woman was admitted to our hospital because of severe headache and sudden stuporous consciousness. Brain CT showed thick SAH and intraventricular hemorrhage. Cerebral angiography demonstrated bilateral VADA. Based on the SAH pattern and aneurysm configurations, the right VADA was considered ruptured. This was trapped with endovascular coils without difficulty. One month later, the contralateral unruptured VADA was protected using a stent-within-a-stent technique, but marked enlargement of the left VADA was detected by 8-months follow-up angiography. Subsequently two times coil packing for pseudosacs resulted in near complete occlusion of left VADA. However, it continued to grow. Covered stents graft below the posterior inferior cerebellar artery (PICA) origin and a coronary stent implantation across the origin of the PICA resulted in near complete obliteration of the VADA. Covered stent graft can be used as a last therapeutic option for the management of VADA, which requires absolute preservation of VA flow.

Pseudoaneurisma de arteria carótida interna tratado con stent cubierto / Covered stent graft treatment of internal carotid artery pseudoaneurysm

Los pseudoaneurismas de la arteria carótida interna son una complicación poco frecuente de traumatismos penetrantes o cerrados, y por lo general de tratamiento quirurgico difícil, debido a que la resolución por esta técnica requiere de amplia exposición cervical, que puede conllevar a daño de uno o varios nervios craneales o de otras extructuras incluidas las vasculares. El diagnóstico puede retardarse si el traumatismo es no penetrante. El usio de stent cubiertos es relativamente nuevo y lucen como una alternativa atractiva. Los pseudoaneurismas tienen alto riesgo de tromboembolismo por lo qu el diagnóstico oportuno es importante. Los stents cubiertos del tipo autoexpandible surgen como una alternativa interesante al tratamiento quirúrgico, con una tasa muy baja de complicaciones. Es necesario dar al paciente una antiagregaciòn plaquetaria dual (aspirina y clopidogrel) o anticoagulación.

Internal carotid artery pseudo aneurysms are a rare complication following blunt or penetrating trauma and its surgical treatment is difficult, because if they are resolved by surgery they need a large cervical exposure, wich could cause cranial nerve damage or damage of structures, such as the vasculature. The use of stent-graft is relatively new and it appears as an attractive alternative. Pseudo aneurysms have a high risk of thromboembolism, so its early detection is important. Auto-expandable Stent- grafts are an attractive alternative to surgical treatment, with a low incident of complications. It is necessary to give the patient dual antiplatelet treatment (Aspirin plus Clopidogrel) or anticoagulation. There are not studies with follow up to determine its safety and efficacy.

Clinical study on transjugular intrahepatic portosystemic shunt creation with 8 mm diameter covered stent-graft / 介入放射学杂志

Objective To evaluate the clinical results of transjugular intrahepatic portosystemic shunt(TIPS)creation with 8 mm diameter covered stent-graft. Methods Ninteen concecutive patients with portal hypertension underwent TIPS creation with 8 mm diameter covered stent-graft for variceal bleeding and/or refractory ascites. Evaluation of the results through observing the improvement of clinical symptom and periodic follow up was carried out. Results Technical success achieved in all patients reaching 100% without related complications. Median follow-up was 13.5 months(ranged, 2.7 - 28 months). One case(1/19,5.3%)showed aggravation of hepatoencephalopathy and 2 others(2/19, 10.5%)revealed rebleeding. The primary patency rate was 100%(16/16)after 6 months, and 87.5%(7/8)after 12 months. Improvement or resolved rate of ascites was 66.7% (12/18). Conclusion TIPS creation with 8 mm diameter covered stent-graft can degrade the incidence of hepatic encephalopathy, improve the rate of TIPS patency and keeping the effective shunt flow.