Stentiranje diseciranih karotidnih arterija kao minimalno invazivna metoda liječenja [Stenting of dissected carotid arteries as a minimally invasive treatment modality]

Vidjak, Vinko and Krnić, Anton and Novačić, Karlo and Slavica, Marko and Lovrenčić-Huzjan, Arijana and Demarin, Vida (2012) Stentiranje diseciranih karotidnih arterija kao minimalno invazivna metoda liječenja [Stenting of dissected carotid arteries as a minimally invasive treatment modality]. Liječnički vjesnik, 134 (1-2). pp. 12-19. ISSN 0024-3477

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Abstract

AIM: The purpose of this paper is to present our experiences with carotid artery stenting in the treatment of dissected carotid arteries, by means of self-expandable stents and selective employment of cerebral protection devices. ----- METHODS: In the period from June 1, 2006 to April 31, 2009, 6 patients with 6 dissected carotid arteries were treated with self-expandable stents (4 internal carotid artery dissections and 2 common carotid artery dissections). Two dissections were of spontaneous origin, 2 were traumatic, and 2 were iatrogenic. We applied cerebral protection filters selectively in 3 patients, based on morphological appearance of lesions. The criterion for the usage of protection devices was caudally oriented opening of the false lumen in order to prevent the possible migration of a thrombus from the false lumen during cranio-caudal deployment of self-expandable stents. We followed-up patients clinically and by means of duplex scanning throughout 12 months. ----- RESULTS: Primary technical success was 100%. During the 12-month follow-up period no clinical or morphological signs of treatment failure were recorded. None of the patients suffered any complication (cerebral vascular insult, transitory ischemic attack, in-stent stenosis or occlusion). ----- CONCLUSION: Carotid stenting, with selective employment of cerebral protection devices, is a successful, minimally invasive, and low risk procedure in the treatment of carotid dissections in cases when conservative treatment does not bring improvement to local finding or patients' general condition.

Abstract in Croatian

Svrha rada: Namjena je ovog rada iznijeti naša iskustva u stentiranju karotidnih arterija kod liječenja disekcija tih arterija. ----- Metode: U razdoblju od 1. 6. 2006. do 31. 4. 2009. liječili smo 6 bolesnika koji su imali ukupno 6 disekcija karotidnih arterija postavljanjem samoširećih stentova (4 disekcije unutarnjih i 2 disekcije zajedničkih karotidnih arterija). Dvije su disekcije bile spontanog, dvije traumatskog, a dvije ijatrogenog uzroka. Rabili smo selektivno cerebralna zaštitna sredstva (kod 3 bolesnika), ovisno o morfologiji lezije. Bolesnike smo pratili klinički i obojenim doplerom tijekom 12 mjeseci. ----- Rezultati: Primarni je tehnički uspjeh zahvata bio 100%-tan. U periodu praćenja nismo zabilježili kliničke i morfološke znakove neuspjeha liječenja. Ni kod jednog bolesnika nismo uočili komplikacije (cerebrovaskularni inzulti, tranzitorne ishemijske atake, stenoze ili okluzije u području stenta). ----- Zaključak: Karotidno stentiranje, uz selektivnu upotrebu cerebralne protekcije, uspješna je, minimalno invazivna i niskorizična metoda liječenja disekcije karotidnih arterija u bolesnika kod kojih konzervativno liječenje ne rezultira boljitkom lokalnog nalaza, odnosno općeg stanja.

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