Trans-carotid Approach for Retrograde Stenting of Proximal Innominate and Common Carotid Artery Stenosis.

Makaloski, Vladimir; von Deimling, Christian; Mordasini, Pasquale; Gralla, Jan; Do, Dai-Do; Schmidli, Jürg; Wyss, Thomas (2017). Trans-carotid Approach for Retrograde Stenting of Proximal Innominate and Common Carotid Artery Stenosis. Annals of vascular surgery, 43, pp. 242-248. Elsevier 10.1016/j.avsg.2017.02.009

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OBJECTIVE To evaluate the hybrid treatment of severe stenosis or occlusion of the proximal innominate (IA) and common carotid artery (CCA) via surgical cut-down of the CCA and distal clamping for cerebral protection against thromboembolic events during retrograde stenting. MATERIALS AND METHODS Consecutive patients undergoing retrograde stenting of proximal IA and CCA stenosis or occlusion via surgical cut-down of the CCA and with distal clamping for prevention of embolisation, with or without concomitant endarterectomy of the carotid bifurcation, between April 1999 and August 2015 were reviewed. Perioperative and long-term outcomes were assessed. RESULTS Thirty-five patients underwent a total of 36 successful interventions. One patient underwent staged bilateral stenting. Additional concomitant carotid endarterectomy was performed in 13 patients (36%). No new neurological symptoms neither perioperatively nor in-hospital were recorded. Thirty-day follow-up revealed one new ipsi- and one new contralateral stroke (6 %) with completely patent stents, no reinterventions and two unrelated deaths (6 %). Median follow-up was 56 months (range 1-197). After 5 and 10 years the Kaplan-Meier estimated overall survival rate was 85% and 52%. Primary assisted patency rate was 94% during follow-up. Overall freedom from re-intervention was 91%. Three re-interventions were performed during the first postoperative year. Three new neurological events occurred during follow-up, one ipsi- (3 %) and two contralateral (6 %). The ipsilateral event occurred during the first year and both contralateral events during the second year postoperatively. CONCLUSION The retrograde hybrid approach to proximal IA and CCA disease is a safe procedure with surgical outflow control preventing perioperative stroke in ipsilateral carotid territory. The majority of relevant in-stent stenoses/occlusions and new neurological events occurred within the first two years, suggesting these patients should undergo regular monitoring early postoperatively. High patency rates without further neurological events can be expected thereafter.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Makaloski, Vladimir; Mordasini, Pasquale; Gralla, Jan; Do, Dai-Do; Schmidli, Jürg and Wyss, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1615-5947

Publisher:

Elsevier

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

08 Aug 2017 09:23

Last Modified:

15 Aug 2017 01:31

Publisher DOI:

10.1016/j.avsg.2017.02.009

PubMed ID:

28478176

URI:

https://boris.unibe.ch/id/eprint/100091

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