PAPER: Aortic Arch Vessel Stenting: A Single-Center Experience Using Cerebral Protection

Surgeon · 22-07-06, 22:24

Hypothesis* Endovascular interventions have revolutionized the contemporary treatment of peripheral vascular occlusive disease. Traditional management of supra-aortic trunk disease has employed surgical extra-anatomic bypass via a cervical approach or median sternotomy. Endoluminal therapy may be a less morbid alternative.
Design and Setting* A retrospective review of procedures performed by vascular surgeons in an operating room angiosuite at a single university-based, tertiary referral center.
Patients* Eighteen consecutive patients with 20 brachiocephalic-origin stenoses.
Interventions* From December 2001 through September 2005, 20 brachiocephalic-origin stenoses were treated endoluminally with balloon-expandable stents. Treated vessels were innominate (n*=*8), common carotid (n*=*9), and subclavian (n*=*3). The target lesion was accessed by one of the following methods: antegrade via the femoral artery (n*=*5), retrograde through the brachial artery (n*=*1), or via a retrograde cut-down on the common carotid artery (n*=*14). Cerebral protection was achieved with either a distal embolic filter device or with open surgical occlusion of the distal common carotid artery.
Main Outcome Measures* We report immediate and midterm outcomes of all aortic arch vessel stenting procedures with mean follow-up of 12 months.
Results* Mean age was 68 years (6 men and 12 women) and overall mean stenosis was 85%. Preprocedural symptoms including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 16 of 20 cases (80%). The 4 asymptomatic patients all had more than 90% stenosis on angiography. At 30-day follow-up, there were no deaths, myocardial infarctions, or strokes. During follow-up, there were no cases of restenosis.
Conclusion* Endoluminal arterial stenting of brachiocephalic arch vessels may be a viable alternative to traditional open bypass in cases of focal stenotic disease.

Read the full article at Archives of Surgery

22-07-06, 22:24	#1
Surgeon Official Forum News Anchor Join Date: Jan 2006 Posts: 4,262	PAPER: Aortic Arch Vessel Stenting: A Single-Center Experience Using Cerebral Protection Hypothesis* Endovascular interventions have revolutionized the contemporary treatment of peripheral vascular occlusive disease. Traditional management of supra-aortic trunk disease has employed surgical extra-anatomic bypass via a cervical approach or median sternotomy. Endoluminal therapy may be a less morbid alternative. Design and Setting* A retrospective review of procedures performed by vascular surgeons in an operating room angiosuite at a single university-based, tertiary referral center. Patients* Eighteen consecutive patients with 20 brachiocephalic-origin stenoses. Interventions* From December 2001 through September 2005, 20 brachiocephalic-origin stenoses were treated endoluminally with balloon-expandable stents. Treated vessels were innominate (n=8), common carotid (n=9), and subclavian (n=3). The target lesion was accessed by one of the following methods: antegrade via the femoral artery (n=5), retrograde through the brachial artery (n=1), or via a retrograde cut-down on the common carotid artery (n=14). Cerebral protection was achieved with either a distal embolic filter device or with open surgical occlusion of the distal common carotid artery. Main Outcome Measures* We report immediate and midterm outcomes of all aortic arch vessel stenting procedures with mean follow-up of 12 months. Results* Mean age was 68 years (6 men and 12 women) and overall mean stenosis was 85%. Preprocedural symptoms including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 16 of 20 cases (80%). The 4 asymptomatic patients all had more than 90% stenosis on angiography. At 30-day follow-up, there were no deaths, myocardial infarctions, or strokes. During follow-up, there were no cases of restenosis. Conclusion* Endoluminal arterial stenting of brachiocephalic arch vessels may be a viable alternative to traditional open bypass in cases of focal stenotic disease. Read the full article at Archives of Surgery
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