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Background The endovascular technique has been recommended over the past few years to extracranial carotid dissection and pseudoaneurysm with promising results, especially after medical therapy failure. Flow-diverting stents are an alternative for complex cases. These stents have proven to be effective treatment devices for intracranial aneurysms. Methods The reference list of Pham’s systematic review, published in 2011, and Seward’s literature review, published in 2015, was considered, as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE and Literatura Latino-Americana e do Caribe em Ciencias da Saude. Results For carotid dissection and pseudoaneurysm, our review yielded 3 published articles including 12 patients. The technical success rate of flow-diverting stent was 100% with no procedural complication described. Mean clinical follow-up was 27.2 months (range 5–48), and in 5 months’ angiographic follow-up, all lesions had healed. No new neurological events were reported during the clinical follow-up. Conclusions Flow diverter stent use on intracranial and peripheral vascular surgery demonstrates satisfactory initial results, but it is still under investigation. There are very few cases treated till now and the initial results with flow-diverting stents to cervical carotid dissection are promising. In well-selected cases, where simple embolization or conventional stent is not appropriate, this technic may be considered.

ObjectiveTo elucidate the histologic changes after stent graft oversizing in nonatherosclerotic aortas using an experimental porcine model. We previously reported that the diameter and angulation of the aorta in this model are similar to those in young individuals who undergo stent graft repair for blunt aortic injuries. The lack of commercially available stent grafts specific for repairing blunt aortic injuries, particularly for small and angulated aortas, may be related to the high rate of endograft complications in this population.MethodsTwenty-five pigs were randomized into one control group (without stent graft implantation) and four oversized groups (A: 10%-19%, B: 20%-29%, C: 30%-39%, and D: >40%). Three circumferential fragments were collected from the aorta for histologic and immunohistochemical studies. Morphometric analyzes were performed using an inflow system and image analysis software (Quantimet 500; Leica Cambridge Ltd, Cambridge, UK).ResultsCollagen expression in the aortic wall was not significantly different among the five groups (P = .5604). There were significantly fewer muscle fibers in the aortic wall in the oversized groups compared with the control group (P = .000198). The proportion of elastic fibers in the aortic wall was significantly smaller in the oversized groups compared with the control group (P = .0000001). Immunohistochemical analysis showed that α-actin expression in the aortic wall was significantly decreased in the oversized groups compared with the control group (P = .002031). There were no significant differences in either the number of muscle fibers or α-actin expression among the four oversized groups.ConclusionsHistologic and immunohistochemical studies confirmed the structural disarrangement of the aortic wall after insertion of an endoprosthesis, including reduced number of muscle and elastic fibers.Clinical RelevanceBlunt aortic injury is a catastrophic event that most commonly affects the descending thoracic aorta, and it is the second most common cause of death in trauma patients. Thoracic endovascular aortic repair is increasingly being used to treat such conditions. The prostheses available at the time we conducted the present study were not specifically designed to treat thoracic aortic trauma. Furthermore, few stent grafts had been designed for use in normal or healthy aortic tissue or in young patients with acute angulation of the thoracic aorta. To our knowledge, no large study has evaluated the optimal target level of oversizing in thoracic aortas, especially for nonatherosclerotic aortas. We have conducted an experimental study in which we evaluated the biomechanical changes associated with four levels of stent graft oversizing on a nonatherosclerotic aortic wall. In the present report, we describe the histologic and immunohistochemical results of that study.