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Jostent covered stent placement for emergency reconstruction of a ruptured internal carotid artery during or after transsphenoidal surgery

Authors
 Byung Moon Kim  ;  Pyoung Jeon  ;  Dong Joon Kim  ;  Dong Ik Kim  ;  Sang Hyun Suh  ;  Keun Young Park 
Citation
 Journal of Neurosurgery, Vol.122(5) : 1223-1228, 2015 
Journal Title
 Journal of Neurosurgery 
ISSN
 0022-3085 
Issue Date
2015
Abstract
OBJECT: Internal carotid artery (ICA) rupture during transsphenoidal surgery (TSS) is an extremely difficult complication to treat. This study aimed to evaluate the immediate and long-term outcomes of covered stent placement for emergency reconstruction of ruptured ICAs during or after TSS. METHODS: Seven patients underwent covered stent placement for emergency reconstruction of a ruptured ICA during or after TSS. The safety and effectiveness of covered stent placement for emergency reconstruction of ruptured ICAs were retrospectively analyzed. RESULTS: Pretreatment angiography showed active bleeding in 6 patients (5 intraoperative and 1 postoperative) and a pseudoaneurysm in 1 patient. Of the 6 patients with active bleeding, 5 were treated with a successive operation to control active bleeding. The other patient was treated just after cardiopulmonary resuscitation due to massive nasal bleeding 20 days after revision of TSS. All active bleeding was controlled immediately after covered stent insertion in these 6 patients. One patient showed a gap between the covered stent and ICA wall without active bleeding 30 minutes after glycoprotein IIb/IIIa inhibitor administration due to in-stent thrombosis. The gap was occluded with coil embolization after completion of the temporarily suspended TSS. The seventh patient, whose ICA tear was treated with surgical suture, underwent covered stent placement for a pseudoaneurysm detected on postoperative Day 2. During a mean follow-up period of 46 months (range 12-85 months), all patients had excellent outcomes (modified Rankin Scale score of 0). All the stented ICAs were patent on vascular imaging follow-up at a mean of 34 months (range 12-85 months). CONCLUSIONS: Covered stents appear to be a safe and effective option for emergency reconstruction of ruptured ICAs during or after TSS.
Full Text
http://thejns.org/doi/10.3171/2014.10.JNS14328
DOI
10.3171/2014.10.JNS14328
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김동익(Kim, Dong Ik)
김동준(Kim, Dong Joon) ORCID logo https://orcid.org/0000-0002-7035-087X
김병문(Kim, Byung Moon) ORCID logo https://orcid.org/0000-0001-8593-6841
박근영(Park, Keun Young)
서상현(Suh, Sang Hyun) ORCID logo https://orcid.org/0000-0002-7098-4901
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140067
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