'Stent-graft' procedure improves outcomes of carotid aneurysm repair
Less-invasive technique speeds recovery, reduces complicationsFor patients with life-threatening aneurysms of the carotid artery in the neck, a minimally invasive stent-grafting technique can be just as effective as traditional open surgery, but with faster recovery and fewer complications, according to a study in the March Journal of Vascular Surgery.
"Minimally invasive treatment using a stent-graft to repair the carotid artery aneurysm (CAA) has become a useful strategy to treat patients with this condition," said Dr. Peter Lin, Associate Professor of Vascular Surgery at Baylor College of Medicine, one of the study authors. "Compared to the open neck operation, we found that the stent-graft approach resulted in less neck nerve injury and faster recovery."
An aneurysm is a ballooning of an artery, resulting from weakening or stretching of the vessel wall. The carotid artery, which is the main blood vessel in the neck, supplies most of the blood flow to the brain. When an aneurysm occurs in the carotid artery, it can get bigger over time, leading to devastating problems such as stroke or rupture of the aneurysm. A CAA can occur after trauma, infection, or previous surgery of the carotid artery.
The researchers compared the results of CAA repair in two eras: 1985 to 1994, when 22 patients were treated by open neck surgery; and 1995 to 2004, when 14 of 20 patients were treated by minimally invasive endovascular procedures such as stent-graft placement. In the stent-graft procedure, the vascular surgeon makes a small incision in the groin to thread a catheter through the patient's arteries. Once the catheter reaches the carotid artery, a small device called a stent-graft is placed inside the aneurysm. The graft is then expanded and fixed in place to repair the aneurysm.
Both approaches had a high success rate, but stent-graft placement offered some important advantages over surgery. Because it doesn't require any incision in the neck, patients undergoing the stent-graft procedure had much less pain and discomfort, with a shorter recovery time. Stent-grafting also had fewer complications, including a lower risk of injury to the cranial nerve in the neck.
"Patients who undergo the carotid artery stent graft procedure can typically resume their normal activities within two days following the treatment," said Dr. Wei Zhou, a co-author of the study. "This is in contrast to two to three weeks of recovery if they undergo the conventional open neck operation. With patients who have underlying lung disease and do not tolerate general anesthesia, this catheter-based procedure can be performed under local anesthesia."
However, the researchers cautioned that not every patient with a CAA is a good candidate for the stent-graft treatment. In some situations, open surgery remains the preferred treatment because the vessel anatomy may not accommodate the placement of a stent-graft. Doctors are hopeful that, with continued advances in technology, this minimally invasive treatment may become more widely applicable in patients with carotid artery aneurysms.
About Journal of Vascular Surgery
Journal of Vascular Surgery provides vascular, cardiothoracic, and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography, and endovascular management. Special issues publish papers presented at the annual meeting of the Journal's sponsoring society, the Society for Vascular Surgery. Visit the journal website at www.jvascsurg.org/.
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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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