Carotid artery stent placement with embolic protection: single-center experience.

PURPOSE: To evaluate the efficacy of carotid artery stent placement with embolic protection. MATERIALS AND METHODS: During a 2-year period (May 2003 to April 2005), 232 patients underwent carotid artery stent placement with the Acculink RX stent-graft and an embolic protection device. There were 150 men (mean age,70 years; age range, 58-85 years) and 82 women (mean age, 76 years; age range, 56-82 years). One hundred sixty-five patients were symptomatic and 67 were asymptomatic. All patients were at high risk for carotid endarterectomy. RESULTS: The procedure was technically successful in 231 patients. The procedure was stopped in one patient due to asystole. In three patients, a cervical approach was necessary owing to aortic arch anatomy. During the procedure,11 patients (4.74%) experienced bradycardia and two developed a major stroke (0.86%). The mean follow-up was 30 months (range, 12-36 months). Four patients died. No stent occlusion was observed. During the late follow-up period(>30 days), two patients (0.86%) had minor strokes, three (1.29%) had nonfatal transient ischemic attacks, and seven(3.01%) had myocardial infarctions. CONCLUSION: Carotid artery stent placement with cerebral protection by using the specific devices compares favorably to previously reported surgical results.

Endovascular repair of traumatic rupture of the thoracic aorta: single-center experience.

PURPOSE: Traumatic rupture of the thoracic aorta secondary to blunt chest trauma is a life-threatening emergency and a common cause of death, usually following violent collisions. The objective of this retrospective report was to evaluate the efficacy of endovascular treatment of thoracic aortic disruptions with a single commercially available stent-graft. METHODS: Nine men (mean age 29.5 years) were admitted to our institution between January 2003 and January 2006 due to blunt aortic trauma following violent motor vehicle collisions. Plain chest radiography, spiral computed tomography, aortography, and transesophageal echocardiography were used for diagnostic purposes in all cases. All patients were diagnosed with contained extramural thoracic aortic hematomas, secondary to aortic disruption. One patient was also diagnosed with a traumatic thoracic aortic dissection, secondary to blunt trauma. All subjects were poor surgical candidates, due to major injuries such as multiple bone fractures, abdominal hematomas, and pulmonary contusions. All repairs were performed using the EndoFit (LeMaitre Vascular) stent-graft. RESULTS: Complete exclusion of the traumatic aortic disruption and pseudoaneurysm was achieved and verified at intraoperative arteriography and on CT scans, within 10 days of the repair in all patients. In 1 case the deployment of a second cuff was necessary due to a secondary endoleak. In 2 cases the left subclavian artery was occluded to achieve adequate graft fixation. No procedure-related deaths have occurred and no cardiac or peripheral vascular complications were observed within the 12 months (range 8-16 months) follow-up. CONCLUSIONS: This is the first time the EndoFit graft has been utilized in the treatment of thoracic aortic disruptions secondary to chest trauma. The repair of such pathologies is technically feasible and early follow-up results are promising.

Management of cervical paragangliomas: review of a 15-year experience.

BACKGROUND AND AIMS: Cervical paragangliomas are highly vascular neoplasms and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors. MATERIALS AND METHODS: Thirteen patients with 14 paragangliomas were treated in our institution during a period of 15 years. There were eight women (61.5%) and five men (38.5%) with a mean age of 41.3+/-15 years. A painless lateral neck mass was the main finding in 69.2% of patients. There was no evidence of a functional tumor. Carotid angiography was performed in all patients to define the vascular anatomy of the lesion. The 78.6% of paragangliomas underwent selective embolization of the major feeding arteries. Surgical resection followed within the next 48 h. RESULTS: The majority of the lesions were paragangliomas of the carotid bifurcation (85.7%), while one patient was diagnosed with a jugular and one with a vagal paraganglioma. In one patient, bilateral paragangliomas in the carotid bifurcation were detected. There was no evidence of malignancy in any case. Preoperative embolization has proven successful in reducing tumor vascularity. Vascular reconstruction was necessary in one patient. The main postoperative complication was transient cranial nerve deficit in seven (53.8%) patients, and a permanent Horner's syndrome was documented in one patient. No stroke occurred. The jugular paraganglioma was treated with irradiation due to skull base extension with significant symptomatic relief. CONCLUSION: Combined therapeutic approach with preoperative selective embolization followed by surgical resection by an experienced team offers a safe and effective method for complete excision of the tumors with a reduced morbidity rate.