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DOI: 10.1055/s-2007-963172
© Georg Thieme Verlag KG Stuttgart · New York
Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents
Treatment of Carotid Artery Aneurysms with Covered StentsPublication History
eingereicht: 12.1.2007
angenommen: 28.3.2007
Publication Date:
05 September 2007 (online)
![](https://www.thieme-connect.de/media/roefo/200710/lookinside/thumbnails/10.1055-s-2007-963172-1.jpg)
Zusammenfassung
Ziel: Untersuchung der primären sowie kurz- und mittelfristigen Erfolgs- und Komplikationsraten bei der Behandlung von Pseudoaneurysmata der zervikalen und intrakraniell/extraduralen Arteria carotis interna (ACI) mit gecoverten Stents. Material und Methoden: In einer Fallserie wurden 8 Patienten mit 9 spontanen, dissektionsbedingten Aneurysmata der zervikalen ACI (5 symptomatisch, 4 inzidentiell) und ein Patient mit einem ophthalmoplegischen Aneurysma der kavernösen ACI mit gecoverten Stents behandelt. Das Aneurysma der kavernösen ACI wurde mit einem PTFE-gecoverten ballonmonierten Stainless-Steal-Stent (Jostent/Graftmaster) behandelt, die übrigen mit selbstexpandierenden PTFE-gecoverten Nitinol-Stents (Symbiot). Die Behandlung erfolgte in Lokalanästhesie unter doppelter Thrombozytenfunktionshemmung. Klinisch-neurologische Symptome und die Bildgebung mit DSA, MRT, CT und Sonografie wurden im Verlauf dokumentiert. Der mittlere Nachuntersuchungszeitraum betrug 14,5 Monate [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30]. Ergebnisse: 8 der 10 Aneurysmata (80 %) konnten erfolgreich mit einem Stent behandelt werden. Dies führte jeweils zur vollständigen Aneurysmaausschaltung und zur Behebung assoziierter Gefäßstenosen. Klinisch relevante Komplikationen traten weder periprozedural noch im Nachbeobachtungszeitraum auf. In zwei Fällen gelang die Stenteinlage über den Aneurysmahals aufgrund erheblicher Gefäßelongationen nicht, sodass diese unter Thrombozytenfunktionshemmung mit einem jeweils stabilen Verlauf kontrolliert wurden. Schlussfolgerung: Die Behandlung von Pseudoaneurysmata der ACI stellt eine Alternative zur Operation oder medikamentösen Sekundärprophylaxe von pseudoaneurysmatischen Veränderungen der ACI dar, die in unserem Patientenkollektiv erfolgreich (80 %) und komplikationslos war. Indikation, Technik und Verlaufsbildgebung werden diskutiert.
Abstract
Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed.
Key words
carotid arteries - angioplasty - cerebral angiografy - stents - aneurysm
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Dr. Axel Rohr
Neurochirurgie Neuroradiologie, UKSH Campus Kiel
Schittenhelmstr. 10
24105 Kiel
Phone: ++49/4 31/5 97 48 06
Fax: ++49/4 31/5 97 49 13
Email: axel.rohr@gmx.de