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

 Byung Moon Kim  ;  Pyoung Jeon  ;  Dong Joon Kim  ;  Dong Ik Kim  ;  Sang Hyun Suh  ;  Keun Young Park 
 JOURNAL OF NEUROSURGERY, Vol.122(5) : 1223-1228, 2015 
Journal Title
Issue Date
Adult ; Carotid Artery Injuries/surgery* ; Emergency Treatment ; Equipment Design ; Female ; Humans ; Intraoperative Complications/surgery* ; Male ; Middle Aged ; Postoperative Complications/surgery* ; Retrospective Studies ; Rupture ; Stents* ; Time Factors ; Treatment Outcome ; Vascular Surgical Procedures/methods
CCF = carotid-cavernous fistula ; ICA = internal carotid artery ; MCA = middle cerebral artery ; TSS = transsphenoidal surgery ; covered stent ; internal carotid artery ; mRS = modified Rankin Scale ; transsphenoidal surgery ; vascular disorders
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.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Park, Keun Young(박근영)
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
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