1/19. Temporary Strecker stent for management of acute dissection in popliteal and crural arteries.Stent placement is a widely used bail-out treatment for dissection of peripheral arteries. Below the level of the superficial femoral artery permanent stenting is complicated by a high incidence of subacute thrombosis and restenosis. We present two cases of arterial occlusion due to acute iatrogenic dissection of the popliteal and distal fibular arteries. Successful treatment was achieved with a new bail-out procedure. Strecker stents were implanted to seal off the dissection flap. stents were retrieved easily after 24 hr using a myocardial biopsy forceps. After stent retrieval the temporarily stented segments were patent and showed a larger lumen compared with segments treated by balloon dilatation alone. Temporary stenting is a simple and safe procedure and offers the advantage of tacking up dissection membranes and preventing recoil. Persistent presence of a metallic implant as a source of continued injury and stimulus for intimal proliferation is avoided.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/19. Tandem intracranial stent deployment for treatment of an iatrogenic, flow-limiting, basilar artery dissection: technical case report.OBJECTIVE AND IMPORTANCE: Intimal dissection constitutes one of the complications associated with angioplasty of intracranial vessels. We present a case of iatrogenic dissection of the entire basilar artery, which was induced by angioplasty and stenting of symptomatic, focal, intracranial vertebral artery stenosis, and its successful treatment with tandem deployment of a downstream stent. CLINICAL PRESENTATION: A 61-year-old, hypertensive, renal transplant recipient presented with orthostatic vertebrobasilar insufficiency that was refractory to medical management, including anticoagulation therapy. angiography revealed an occluded right vertebral artery and focal, high-grade, left intracranial vertebral artery stenosis. magnetic resonance imaging showed multiple posterior fossa infarctions. The left intracranial vertebral artery stenosis was successfully treated with primary stent deployment and balloon angioplasty, with symptom resolution. On postprocedure Day 2, the patient noted worsening right hemiparesis. INTERVENTION: Subsequent angiography revealed a flow-limiting, windsock-type, basilar artery dissection beginning at the distal end of the left vertebral artery stent and extending to the origin of the left posterior cerebral artery. A tandem stent was navigated intracranially and deployed past the first one, successfully sealing the dissection inflow zone and reconstituting normal flow to the top of the basilar artery. A clinical follow-up examination at 3 months revealed no further orthostatic symptoms and only mild residual right-sided weakness. CONCLUSION: This is the first description of iatrogenic stent-induced dissection of the entire basilar artery that was successfully treated by inflow zone control via tandem intracranial stent deployment.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
3/19. Type A dissection of the ascending thoracic aorta during percutaneous coronary intervention.Retrograde dissection of the aorta is extremely rare during percutaneous coronary intervention (PCI), but is a recognized and potentially life-threatening complication. We describe a case in which retrograde dissection of the aorta, necessitating urgent surgical repair, occurred during an attempt to open a chronically occluded right coronary artery. Initially localized, the dissection extended during an attempt to seal the right coronary ostium. Our experience suggests that if localized aortic retrograde dissection occurs, the management will depend on the stability of the distal coronary vessel. If stable, a conservative approach may be preferable to an attempt to seal the dissection.- - - - - - - - - - ranking = 2keywords = seal (Clic here for more details about this article) |
4/19. Interventional treatment of lateral tunnel dehiscence in a total cavopulmonary connection using a balloon expandable covered stent.In this paper we present a patient with dehiscence of an intra-atrial tunnel previously constructed during a total cavopulmonary connection procedure. We describe the use of a custom made covered stent to seal off the dehisced segment, and abolish the intra-cardiac shunting. We believe this is the first account of such a procedure being undertaken.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
5/19. Percutaneous balloon-expandable stents for sealing of acute aortic dissection.Acute aortic dissection is a highly lethal disease. When dissection involves only the descending aorta and there are no ischemic complications, medical management may be the treatment of choice. However, a high risk of expansion or rupture of the dissection remains. When renal or limb ischemic complications do appear, surgery has been the only option, despite high mortality and morbidity. Percutaneous placement of stents for sealing an acute aortic dissection might be an alternative to surgical treatment. We treated 2 patients with acute type B aortic dissection by stent-fixation of the proximal and distal descending aorta. In both patients, there was evidence of persistent flap fixation at midterm follow-up.- - - - - - - - - - ranking = 5keywords = seal (Clic here for more details about this article) |
6/19. Intentional left subclavian artery occlusion by thoracic aortic stent-grafts without surgical transposition.PURPOSE: To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery. case reports: Three patients with an aortic type-B dissection and 1 with a thoracic aneurysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months. CONCLUSIONS: Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
7/19. Rapid evolution from coronary dissection to pseudoaneurysm after stent implantation: a glimpse at the pathogenesis using intravascular ultrasound.Coronary dissection during angioplasty can evolve into pseudoaneurysm. Stenting should prevent this complication. We present a case of coronary pseudoaneurysm after dissection that developed despite stent implantation. Intravascular ultrasound demonstrated no sealing of the false lumen due to undersizing and non-apposition to the wall by the stent.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
8/19. Open surgical intervention to recurrent aortic dissection after endovascular stent grafting.We report the case of a 49-year-old man who received open-heart surgery for recurrent aortic dissection after endovascular stent grafting. Stent grafting had been successfully performed in the acute phase. Recurrent dissection became obvious 5 months later, and at the same time, aneurysmal change was detected between the left subclavian artery and the proximal end of the stent graft. We employed a "Y arch" surgical procedure and "elephant trunk" technique to treat, and the entry tear was completely sealed and the aneurysm was excluded by elephant trunk segment. We believe that this approach could be a new option for treatment for complicated aortic aneurysms.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
9/19. Deployment of endograft in the ascending aorta to reverse type A aortic dissection.Current surgery to treat acute type A aortic dissection involving an intimal tear in the ascending aorta consists of resection and replacement, but mortality is high. We report the case of a 46-year-old female patient with marfan syndrome who presented with excruciating retrosternal pain and breathing distress after a bowel movement with stress. magnetic resonance imaging and multicolour sonography showed type A aortic dissection extending from the aortic root to the right iliac artery, with intimal tears in the ascending aorta above the sinotubular junction, the distal arch beyond the left subclavian artery and the isthmic region. We adapted the endoluminal stenting technique to this case of type A aortic dissection by sealing the intimal tears in the ascending aorta using endovascular introduction of one endoluminal graft, as confirmed on angiography. The patient was discharged after 10 days. Follow-up examination by computed tomography after more than 1 year revealed no sign of dissection at any level of the aorta.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
10/19. Covered stent: a novel percutaneous treatment of iatrogenic aortic dissection during coronary angioplasty.We present a case of bidirectional dissection, with antegrade extension to the right coronary artery and retrograde extension to the sinus of valsalva and the ascending aorta. The aortocoronary dissection appeared during percutaneous angioplasty to the right coronary artery. The entry site was successfully sealed by a covered stent.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
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