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December 23, 2005
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GianLuca Faggioli, MD, Monica Ferri, MD, Cristina Rossi, MD, Franco Losinno, MD, Mauro Gargiulo, MD, Andrea Stella, MD.
University of Bologna, Vascular Surgery, Policlinico S.Orsola, Bologna, Italy.
OBJECTIVES: Carotid stenting (CAS) is increasingly proposed as an alternative treatment for carotid stenosis. Little data is available on the results of “rescue” in the event of CAS failure. We have analyzed a series of carotid stenting failures treated by conventional open surgery (COS)
METHODS: : Five patients underwent COS after failure of CAS, either electively (4) or emergently (1). Three of these patients were referred to us from other hospitals. Indications for elective surgical “rescue” after stenting was either in stent restenosis (2 cases) or residual stenosis after stent misplacement or incomplete dilation, with the patient asking for a “definitive” procedure (2 cases). Emergent COS was performed for unrecoverable entrapment of the protection system in the stent in one case
RESULTS: Surgical rescue was accomplished by proximal and distal carotid clamping, perimedial endarterectomy with plaque and stent extraction as a unit and subsequent patch closure in 3 cases , and by saphenous vein bypass, with the stent left in place in the remaining 2 elective cases. Saphenous vein bypass was performed because of the need for more distal dissection and control of the internal carotid artery, due to the presence of additional distal ICA plaque. Presence of endoluminal thrombus was macroscopically detected in all cases. Successful restoration of carotid patency with no neurological complication was achieved in every case.
CONCLUSIONS: Failure of CAS can be overcome with low risk by prompt or delayed COS according to type of complication and type of onset. Choice of technique is dependent on case presentation, operator’s experience and distal extension of disease.
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Carotid Stent Failure: Results of Surgical Rescue
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GianLuca Faggioli, MD, Monica Ferri, MD, Cristina Rossi, MD, Franco Losinno, MD, Mauro Gargiulo, MD, Andrea Stella, MD.
University of Bologna, Vascular Surgery, Policlinico S.Orsola, Bologna, Italy.
OBJECTIVES: Carotid stenting (CAS) is increasingly proposed as an alternative treatment for carotid stenosis. Little data is available on the results of “rescue” in the event of CAS failure. We have analyzed a series of carotid stenting failures treated by conventional open surgery (COS)
METHODS: : Five patients underwent COS after failure of CAS, either electively (4) or emergently (1). Three of these patients were referred to us from other hospitals. Indications for elective surgical “rescue” after stenting was either in stent restenosis (2 cases) or residual stenosis after stent misplacement or incomplete dilation, with the patient asking for a “definitive” procedure (2 cases). Emergent COS was performed for unrecoverable entrapment of the protection system in the stent in one case
RESULTS: Surgical rescue was accomplished by proximal and distal carotid clamping, perimedial endarterectomy with plaque and stent extraction as a unit and subsequent patch closure in 3 cases , and by saphenous vein bypass, with the stent left in place in the remaining 2 elective cases. Saphenous vein bypass was performed because of the need for more distal dissection and control of the internal carotid artery, due to the presence of additional distal ICA plaque. Presence of endoluminal thrombus was macroscopically detected in all cases. Successful restoration of carotid patency with no neurological complication was achieved in every case.
CONCLUSIONS: Failure of CAS can be overcome with low risk by prompt or delayed COS according to type of complication and type of onset. Choice of technique is dependent on case presentation, operator’s experience and distal extension of disease.
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