STENTING OF DISSECTED CAROTID ARTERIES AS A MINIMALLY INVASIVE TREATMENT MODALITY
Autori:
Vinko Vidjak, Anton Krnić, Karlo Novačić, Marko Slavica, Arijana Lovrenčić-Huzjan, Vida Demarin
Sažetak
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.
Summary
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.
