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Purpose: To compare the results of carotid stenting and carotid surgery in a consecutive group of 455 patients (482 lesions). Methods: Between January 1995 and July 2002, 107 patients (114 lesions) were treated with carotid stenting and 348 patients (368 lesions) with carotid surgery. A cerebral protection device was routinely used in the last 46 stent cases. All patients were followed with duplex examination at 1 and 6 months postoperatively and yearly thereafter. Results: The stent and surgery groups were similar in terms of mean age (70.5 and 71.1 years, respectively), sex distribution (men 72% versus 75%), and symptoms (transient ischemic attack [TIA] or minor stroke 32.7% versus 42.2%). Median follow-up was 15 months in stent patients and 14 months in the surgical group. At 1 month postoperatively, there were 7 minor strokes (5 temporary lasting Conclusions: This series showed encouraging and comparable major stroke and deaths rate of carotid stenting and carotid surgery. However, there was more restenosis in the stented group on midterm follow-up.

Abdominal aortic aneurysm (AAA) resection is a major surgical procedure performed frequently. As a minimal access procedure, laparoscopy has been shown in the field of general surgery to improve a patient's postoperative well-being and to shorten hospital stay. The same benefits could be expected from a laparoscopic approach for AAA repair. We report what we believe to be the first totally laparoscopic AAA repair performed according to the principles of endoaneurysmorrhaphy. (J Vasc Surg 2001;33:181-5.)

Purpose: The purpose of this study was to assess the feasibility of insertion of endovascular stents and the precision of an open-field interventional magnetic resonance imaging (iMRI) system in an in vivo model. Methods: A feasibility study was undertaken at a university-affiliated hospital. Three male piglets with an average age of 6 months and a weight between 70 and 77 kg and two 3-month-old male piglets that weighed 40 to 44 kg were anesthetized. The five piglets underwent placement of nitinol stents inserted through the right femoral artery, under the guidance of a SIGNA-SP 0.5T open-configuration iMRI unit. With a dedicated high-resolution near–real-time MRI sequence, the stent was guided and deployed onto a predefined target. Results: The main outcome measures were the duration of the procedure from the beginning of positioning to the end of deployment of the stent, the final position of the stent in relation to the target on the iMRI screen, and comparison with autopsy findings. Three stents were deployed within the aorta at the level of the renal arteries, and two were deployed within the right iliac artery just below the aortic trifurcation. The average duration of the endovascular deployment was 13 minutes. There was an agreement of 0.6 mm in the position of the stent as observed on iMR images and found at autopsy. When the piglets were sacrificed, the average distance between the stents and the predefined target was 7.8 mm, mostly because of the migration of one stent. Axial views allowed for accurate determination of stent impaction on the vascular wall. Conclusions: This study confirms the feasibility of stent deployment under near–real-time MRI guidance. It also emphasizes some inherent characteristics that hold promise with regard to other conventional techniques: stents and vascular structures are visualized in near–real-time in any desired plane, and the technique is performed without the potential adverse effects of ionizing radiations and iodinated contrast agents. (J Vasc Surg 2000;32:1006-14.)