Management of wrong coverage of carotid artery during endovascular repair of type Ⅲ aortic dissection by stented graft / 中华普通外科杂志

ABSTRACT

Objective To evaluate the management of wrong coverage of the left common carotid artery ( CCA ) during interventional treatment of type Ⅲ aortic dissection by stented graft. Methods Coverage of the left CCA occurred in four cases during endovascular repair of type Ⅲ aortic dissection using stented graft. All four cases were male. The ages ranged from 37 to 45 years old with the average of 41. The first case was due to moving proximally of the first stented graft during delivery of one more cuff because of endoleak. Recanalization of the left CCA and subclavian artery ( SA) was acquired through sliding distally of the stented graft with the help of an aortic balloon. Coverage of the left CCA and SA in the second case was due to jumping-forward of stented graft during deploying, we dragged the stented graft distally through the pigtail catheter introduced from the left brachial artery with the help of a trap device. Then, the covered left CCA and SA were recanalized. The 2/3 left CCA was covered because of mislocation of the left CCA for the 3rd case. We recanalized the covered left CCA using chimney technique with the exposure of the left CCA. For the 4th case, half the innominate artery, the left CCA and SA were covered because the performer mistake the stented graft without naked stent as one with proximal naked stent. A bypass of assending aorta to bi-carotid arteries and the left axillary artery was performed using vascular graft one month after the endovascular repair. Result The proximal intimal entry was sealed successfully in all four cases. No endoleak, cerebral infarction and ischemia of the left upper limb occurred. Conclusion In cases of wrong coverage of carotid artery during endovascular repair of type Ⅲ aortic dissection, the CCA must be recanalized as soon as possible through surgical or interventional treatment in order to avoiding cerebral ischemia.