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1. Choices of stent and cerebral protection in the ongoing ACST-2 trial: a descriptive study

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
Plaque echolucency, Time Factors, medicine.medical_treatment, Practice Patterns, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, Occlusion, Carotid artery stenosis, Carotid Stenosis, Practice Patterns, Physicians', Stroke, Endarterectomy, Plaque, Atherosclerotic, Endarterectomy, Carotid, Endovascular Procedures, Plaque, Atherosclerotic, Treatment Outcome, Cerebrovascular Circulation, Stents, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid artery stenting, medicine.medical_specialty, Clinical Decision-Making, education, Cerebral protection devices, Stent design, Surgery, Prosthesis Design, Asymptomatic, Embolic Protection Devices, 03 medical and health sciences, Severity of illness, medicine, Humans, Carotid, Chi-Square Distribution, Physicians', business.industry, Patient Selection, Stent, METANÁLISE, medicine.disease, Asymptomatic Diseases, Cerebrovascular Disorders, Stenosis, business, 030217 neurology & neurosurgery
Abstract

Objectives Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Materials and methods Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90–99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. Results In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90–99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. Conclusions In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

Published
2017

2. Erratum to 'Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study' [Eur J Vasc Endovasc Surg 53 (2017) 617–625]

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
medicine.medical_specialty, Surgery, Cardiology and Cardiovascular Medicine, business.industry, Published Erratum, medicine.medical_treatment, Physical therapy, medicine, MEDLINE, Stent, Descriptive research, business
Published
2017
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3. Aortic debranching from the ascending aorta: a novel surgical approach for extended TAAA and chronic type B dissections in high risk patients

Author

T, Abdulamit, N, Mangialardi, A, Petrosyan, P, Costa, J J, Albrand, J C, Trastour, and P, Bergeron

Subjects
Aged, 80 and over, Male, Aortic Aneurysm, Thoracic, Aorta, Thoracic, Middle Aged, Prosthesis Design, Blood Vessel Prosthesis, Aortic Dissection, Treatment Outcome, Risk Factors, Chronic Disease, Humans, Female, Vascular Surgical Procedures, Aged, Follow-Up Studies, Retrospective Studies
Abstract

Extend thoraco-abdominal aortic aneurysms (TAAA) involving arch vessels and the visceral arteries remains a challenging operation when affecting high risk patients (HRP). Recently, hybrid surgery has gained popularity for HRP. The conventional surgical repair is the gold standard for low risk patients with previous mortality from 6% to 15% in thoracic aneurysms up to 30% in thoracic type B dissections. The risk of paraplegia is 3% to 15%. Without repair the outcome is poor with only 35% of patient's survival at two years after diagnosis. The total endovascular technique is not widespread used because of its very time-consuming, needs training, and procedure planning with high radiation exposure. Only few centers in the world perform it. In order to reduce the morbidity a novel approach is proposed, with an aortic debranching from the ascending aorta.Nine patients (two females) aged between 53 and 81 years, with high risk factors for surgery, were offered this hybrid technique from March 2004 to July 2009. Eight patients presented with a TAAA and one type a B chronic dissection. A staged hybrid operation started by a debranching of the aorta from a median sternotomy to supra-aortic vessels and visceral arteries, followed by the second stage one-two weeks later, with an extended stent grafting. This attitude avoids CPB and aortic cross clamping. The surgical approach is a median sternotomy combined to mid upper laparotomy associated to pericardial and diaphragm division. It is well tolerated even in elderly patients and allows easy access to celiac axis (CA), superior mesenteric artery (SMA), right renal artery (RRA). Access to the left renal artery is more difficult and may be benefit from a combinated stent grafting and bypass according to the VORTEC technique described by Lachat M, or an extra-anatomic bypass. Rerouting the visceral arteries is done from the ascending aorta with a partial clamping on an undiseased implantation site, offering à good anterograde high flow. Combined bypass to supraaortic vessels is associated when needed.There was no intraoperative mortality. One patient died during 30D period from cardiac failure and another on the early follow up from a pancreatic fistula. The complications: one stroke (11.1%); one cardiac failure (11.1%); one renal failure (11.1%), one pancreatic fistula (11.1%), one non-infected retrostrenal collection (11.1%). No paraplegia, limb ischemia or aortic fistula were detected. No stent-graft related complication was retrieved, the bypass patency was 77.7 at four-year survival.Our early and mid term results are promising and similarly to other series. This new approach for rerouting the supraaortic and visceral arteries before stent grafting in extended TAAA, lowers the surgical injury and is particularly designed for HRP who cannot benefit from conventional surgery under CPB. Larger series and longer follow-up are needed.

Published
2012

4. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection

Author

J K, Bellos, A, Petrosyan, T, Abdulamit, J C, Trastour, and P, Bergeron

Subjects
Aortic Dissection, Blood Vessel Prosthesis Implantation, Treatment Outcome, Aortic Aneurysm, Thoracic, Recurrence, Humans, Stents, Prosthesis Design, Tomography, X-Ray Computed, Aortography, Blood Vessel Prosthesis
Abstract

Thoracic endovascular aortic repair (TEVAR) has emerged as promising and a less invasive alternative to open surgery for high risk patients (HRP) with type B thoracic aortic dissection (TAD). One of the most serious complication of TEVAR is the retrograde type A TAD (rATAD). This review will focus on an interesting rATAD case and will review the literature, regarding the true incidence, mortality, causes, diagnosis, complications and management of rATAD. Until the development of a specific device for TAD, efforts must be made for better patient and device selection, careful and precise instrumentation, and life-long surveillance to minimize this lethal complication.

Published
2010

5. Percutaneous cervical approach and closing for carotid artery stenting

Author

F, Markatis, A, Petrosyan, T, Abdulamit, J-C, Trastour, and P, Berge-Ron

Subjects
Treatment Outcome, Angioplasty, Suture Techniques, Humans, Carotid Stenosis, Stents, Equipment Design, Punctures, Neck, Catheterization
Abstract

The standard route for carotid artery stenting (CAS) is the femoral one, leaving the brachial access as a secondary option. Various anatomic specifications, or occlusions of the routing arteries, make carotid stenting impossible. Percutaneous cervical puncture of the common carotid artery, is a method which can solve access problems. We are presenting the experience from 191 CAS procedures through cervical puncturing and closure of the puncture site in order to prove its safety and efficacy.

Published
2009

6. Choice of access for percutaneous carotid angioplasty and stenting: a comparative study on cervical and femoral access

Author

X, MATHIEU, V, PIRET, P, BERGERON, A, PETROSYAN, T, ABDULAMIT, and J C, TRASTOUR

Subjects
Carotid Artery Diseases, Femoral Artery, Stroke, Carotid Arteries, Ischemic Attack, Transient, Patient Selection, Humans, Stents, Risk Assessment, Angioplasty, Balloon, Retrospective Studies
Abstract

Carotid angioplasty and stenting (CAS) is a well established technique. CAS indications currently still limited are yet evolving. The choice of the access is defined by the risk factors of the patient among whom ''the vascular anatomy'' is essential. The authors will focus here on the accesses, their advantages and their drawbacks. They made a retrospective study relating 314 patients treated by CAS. No significant difference in term of morbidity or mortality between the cervical or femoral access was found but a clear tendency in favor of the cervical access which avoids the arch manipulations. It can be concluded that various access offer better options for CAS and must be discussed depending on the patient's anatomy and risks factors.

Published
2009

7. Acute carotid stent thrombosis: a case of surgical revascularization and review of treatment options.

Author

Markatis F, Petrosyan A, Abdulamit T, and Bergeron P

Subjects
Acute Disease, Aged, Carotid Stenosis diagnostic imaging, Device Removal, Humans, Male, Radiography, Thrombosis diagnostic imaging, Thrombosis etiology, Time Factors, Treatment Outcome, Angioplasty, Balloon adverse effects, Angioplasty, Balloon instrumentation, Carotid Stenosis therapy, Endarterectomy, Carotid, Stents, Thrombectomy, Thrombosis surgery
Abstract

Carotid artery stenting is considered to be an alternative to carotid endarterectomy for selected patients by many vascular specialists around the world. Acute stent thrombosis following the procedure, although very infrequent, can risk the survival of the patient. In this report, we present a case of acute stent thrombosis 24 hours following the procedure. After a slow deterioration of the clinical state of the patient, he was urgently subjected to thrombectomy with extraction of the stent, with eventual resolution of his symptoms. A review of the current literature is presented together with all the possible treatment options of this serious complication. In conclusion, several neurorescue procedures are available for the vascular surgeon who has to act urgently and, in some cases, aggressively, when stent thrombosis is diagnosed.

Published
2012
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8. Hybrid repair with antegrade visceral artery debranching: the preferred treatment option for thoracoabdominal aneurysms in high-risk patients.

Author

Markatis F, Petrosyan A, Abdulamit T, and Bergeron P

Subjects
Aged, Aortic Aneurysm, Thoracic diagnostic imaging, Aortography methods, Arteries surgery, Blood Vessel Prosthesis Implantation adverse effects, Female, France, Humans, Male, Postoperative Complications etiology, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation methods, Endovascular Procedures adverse effects, Viscera blood supply
Abstract

Purpose: To present a hybrid repair technique that may decrease the morbidity and mortality associated with thoracoabdominal aneurysm (TAAA) repair, especially in high-risk patients., Methods: A retrospective analysis was performed of patients treated for TAAA at a single institution from 2005 to 2010. Nine patients (8 men; mean age 72 years) with Crawford types II or IV TAAAs were treated with a 2-stage hybrid technique consisting of antegrade visceral debranching of the aorta, followed within a month by endovascular deployment of endografts to cover the entire diseased aortic segment., Results: There was no perioperative mortality, paraplegia, or permanent renal failure. Following the debranching procedure, there were 4 cases of transient renal dysfunction, 1 minor stroke (resolved), and 1 low-flow pancreatic fistula that regressed. There were no complications after the endovascular repair. Over a mean follow-up of 28 months (range 8-50), all patients are alive, with good patency of the bypass grafts and endografts. One late type II endoleak is under surveillance., Conclusion: This small series shows that the ascending aorta is a safe location for antegrade visceral debranching, which could facilitate hybrid repair in most cases, especially those patients with advanced lesions of the iliac arteries. More patients and longer follow-up are required to draw definite conclusions for the adoption of this treatment in high-risk patients.

Published
2012
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9. Aortic debranching from the ascending aorta: a novel surgical approach for extended TAAA and chronic type B dissections in high risk patients.

Author

Abdulamit T, Mangialardi N, Petrosyan A, Costa P, Albrand JJ, Trastour JC, and Bergeron P

Subjects
Aged, Aged, 80 and over, Aortic Dissection diagnosis, Aortic Aneurysm, Thoracic diagnosis, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prosthesis Design, Retrospective Studies, Risk Factors, Treatment Outcome, Aortic Dissection surgery, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Vascular Surgical Procedures methods
Abstract

Aim: Extend thoraco-abdominal aortic aneurysms (TAAA) involving arch vessels and the visceral arteries remains a challenging operation when affecting high risk patients (HRP). Recently, hybrid surgery has gained popularity for HRP. The conventional surgical repair is the gold standard for low risk patients with previous mortality from 6% to 15% in thoracic aneurysms up to 30% in thoracic type B dissections. The risk of paraplegia is 3% to 15%. Without repair the outcome is poor with only 35% of patient's survival at two years after diagnosis. The total endovascular technique is not widespread used because of its very time-consuming, needs training, and procedure planning with high radiation exposure. Only few centers in the world perform it. In order to reduce the morbidity a novel approach is proposed, with an aortic debranching from the ascending aorta., Methods: Nine patients (two females) aged between 53 and 81 years, with high risk factors for surgery, were offered this hybrid technique from March 2004 to July 2009. Eight patients presented with a TAAA and one type a B chronic dissection. A staged hybrid operation started by a debranching of the aorta from a median sternotomy to supra-aortic vessels and visceral arteries, followed by the second stage one-two weeks later, with an extended stent grafting. This attitude avoids CPB and aortic cross clamping. The surgical approach is a median sternotomy combined to mid upper laparotomy associated to pericardial and diaphragm division. It is well tolerated even in elderly patients and allows easy access to celiac axis (CA), superior mesenteric artery (SMA), right renal artery (RRA). Access to the left renal artery is more difficult and may be benefit from a combinated stent grafting and bypass according to the VORTEC technique described by Lachat M, or an extra-anatomic bypass. Rerouting the visceral arteries is done from the ascending aorta with a partial clamping on an undiseased implantation site, offering à good anterograde high flow. Combined bypass to supraaortic vessels is associated when needed., Results: There was no intraoperative mortality. One patient died during 30D period from cardiac failure and another on the early follow up from a pancreatic fistula. The complications: one stroke (11.1%); one cardiac failure (11.1%); one renal failure (11.1%), one pancreatic fistula (11.1%), one non-infected retrostrenal collection (11.1%). No paraplegia, limb ischemia or aortic fistula were detected. No stent-graft related complication was retrieved, the bypass patency was 77.7 at four-year survival., Conclusion: Our early and mid term results are promising and similarly to other series. This new approach for rerouting the supraaortic and visceral arteries before stent grafting in extended TAAA, lowers the surgical injury and is particularly designed for HRP who cannot benefit from conventional surgery under CPB. Larger series and longer follow-up are needed.

Published
2012

10. Retrograde type A aortic dissections after endovascular stent-graft placement for type B dissection.

Author

Bellos JK, Petrosyan A, Abdulamit T, Trastour JC, and Bergeron P

Subjects
Aortic Dissection diagnostic imaging, Aortic Aneurysm, Thoracic diagnostic imaging, Aortography methods, Blood Vessel Prosthesis Implantation adverse effects, Humans, Prosthesis Design, Recurrence, Tomography, X-Ray Computed, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Stents
Abstract

Thoracic endovascular aortic repair (TEVAR) has emerged as promising and a less invasive alternative to open surgery for high risk patients (HRP) with type B thoracic aortic dissection (TAD). One of the most serious complication of TEVAR is the retrograde type A TAD (rATAD). This review will focus on an interesting rATAD case and will review the literature, regarding the true incidence, mortality, causes, diagnosis, complications and management of rATAD. Until the development of a specific device for TAD, efforts must be made for better patient and device selection, careful and precise instrumentation, and life-long surveillance to minimize this lethal complication.

Published
2010

11. Percutaneous cervical approach and closing for carotid artery stenting.

Author

Markatis F, Petrosyan A, Abdulamit T, Trastour JC, and Berge-Ron P

Subjects
Equipment Design, Humans, Neck, Treatment Outcome, Angioplasty methods, Carotid Stenosis surgery, Catheterization instrumentation, Punctures, Stents, Suture Techniques instrumentation
Abstract

The standard route for carotid artery stenting (CAS) is the femoral one, leaving the brachial access as a secondary option. Various anatomic specifications, or occlusions of the routing arteries, make carotid stenting impossible. Percutaneous cervical puncture of the common carotid artery, is a method which can solve access problems. We are presenting the experience from 191 CAS procedures through cervical puncturing and closure of the puncture site in order to prove its safety and efficacy.

Published
2009

12. Choice of access for percutaneous carotid angioplasty and stenting: a comparative study on cervical and femoral access.

Author

MATHIEU X, PIRET V, BERGERON P, PETROSYAN A, ABDULAMIT T, and TRASTOUR JC

Subjects
Humans, Ischemic Attack, Transient etiology, Retrospective Studies, Risk Assessment, Stroke etiology, Angioplasty, Balloon adverse effects, Angioplasty, Balloon instrumentation, Angioplasty, Balloon methods, Carotid Arteries, Carotid Artery Diseases therapy, Femoral Artery, Patient Selection, Stents
Abstract

Carotid angioplasty and stenting (CAS) is a well established technique. CAS indications currently still limited are yet evolving. The choice of the access is defined by the risk factors of the patient among whom ''the vascular anatomy'' is essential. The authors will focus here on the accesses, their advantages and their drawbacks. They made a retrospective study relating 314 patients treated by CAS. No significant difference in term of morbidity or mortality between the cervical or femoral access was found but a clear tendency in favor of the cervical access which avoids the arch manipulations. It can be concluded that various access offer better options for CAS and must be discussed depending on the patient's anatomy and risks factors.

Published
2009

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