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Endovascular repair of branch-artery adjacent aneurysm using bare stents – preliminary experience
裸支架治疗累及分支动脉的动脉瘤的初步经验
Qu Lefeng曲乐丰
Department of Vascular Surgery ，Changhai Hospital, Shanghai, China
上海长海医院血管外科
西南血管论坛 -2011
Vascular Symposium Of Southwest China
Initiation of EVAR in 1990
First English language-publication by Juan Parodi et al in 19911
J.C. Parodi Parodi’s initial EVAR device in 1990
1 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491-9
Endovascular Aortic Aneurysm Repair EVAR
Thoracic Endovascular Aortic Repair TEVAR
13 patients treated with home-made stent-grafts over a 2-year period
All successfully deployed
No patients died or had a stroke, no paraplegia or distal embolization
Attractive !!
The first English-language report by Dake et al in 19941
N Engl J Med 1994;331:1729-34
Initiation of TEVAR in 1992
Michael Dake
Both EVAR & TEVAR were in non-branch-artery related (bare) aorta
Both EVAR & TEVAR were in non-branch-artery related (bare) aorta
Two reasons1. Sufficient landing zones for both proximal and distal anchoring parts
2. No interferences of blood supply for the adjacent organs
主动脉分为主动脉分为 ::33 “ ”个 裸区 （“ ”个 裸区 （ NNudeude ））
33 “ ”个 血管区“ ”个 血管区 ((VVisceral)isceral)
N1N1 升主动脉区和升主动脉区和 V2V2 主主动脉弓区的亚分区动脉弓区的亚分区
A
““3N3V” Classification: Special for EVAR & TEVAR3N3V” Classification: Special for EVAR & TEVAR
But, a lot of branch-artery related aneurysms
Fenestrated or branched stent graft
Debranching techniques hybrid with endovascular procedures
Current solutions
Is there a simple, safe and effective way ?
Yes. Bare Stents.
1. Bare stent assisted coiling
Concept from intracranial aneurysm embolization
Bare stent assisted coiling for Congenital isolated kidney with a renal artery aneurysm
A 46-year-old man, single right kidney with a giant aneurysm
Bare stent assisted dense coiling
Bare stent assisted coiling for Congenital isolated kidney with a renal artery aneurysm
One-year follow up
Bare stent assisted coiling for Congenital isolated kidney with a renal artery aneurysm
One-year follow up
Bare stent assisted coiling for Congenital isolated kidney with a renal artery aneurysm
2. Double overlapping bare stents
Hyo-Sung Kwak, et al.Treatment of Splenic Artery Aneurysm with DoubleOverlapping Bare Stents: Case Report. J Korean Radiol Soc 2004;51:291-294
Benndorf G, et al. Overlapping stents for treatment of a dissecting carotid artery aneurysm. J Endovasc Ther 2001;8:566-570
Benndorf G, et al. Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 2001;22:1844-1848
Joseph G, et al. Superimposition of two Wallstents to resolve iatrogenic dissection of an internal carotid artery loop. Indian Heart J 2000;52:335-338
Double overlapping bare stents for iliac aneurysm
Double overlapping bare stents for iliac aneurysm
Deployment of 1st stent DSA after 1st stent
Double overlapping bare stents for iliac aneurysm
Deployment of 2nd stent DSA after 2nd stent
Pre-Endo Post-Endo
Double overlapping bare stents for iliac aneurysm
Double overlapping bare stents and coils for SMA aneurysm
Pre-Endo Pre-Endo
Double overlapping bare stents and coils for SMA aneurysm
1st stent 1st stent with coils
Double overlapping bare stents and coils for SMA aneurysm
Pre-Endo Two stents with coils
Double overlapping bare stents and coils for SMA aneurysm
Two weeks follow-up Two weeks follow-up
3. Multi-layer bare stents
MICHAEL. HENRY* MD, MICHAEL. HENRY* MD, F.A.H.A., F.A.C.A. ,F.E.S.C., F.A.S.A., F.I.C.I.C. F.A.H.A., F.A.C.A. ,F.E.S.C., F.A.S.A., F.I.C.I.C.
INTERVENTIONAL CARDIOLOGISTINTERVENTIONAL CARDIOLOGIST
Ruffino MA* for the Italian CMPS Procedures Registry Group
Presented at Endovascology 2009, Shanghai
Presented at CIRSE 2010, Valencia, Spain
M. HENRY* MDM. HENRY* MD, , F.A.H.A., F.A.C.A. ,F.E.S.C., F.A.S.A., F.I.C.I.C. F.A.H.A., F.A.C.A. ,F.E.S.C., F.A.S.A., F.I.C.I.C.
INTERVENTIONAL CARDIOLOGISTINTERVENTIONAL CARDIOLOGIST
A.POLYDOROU MD, A. BENJELLOUN , A.POLYDOROU MD, A. BENJELLOUN ,
I. HENRY MD , M. HUGEL RN I. HENRY MD , M. HUGEL RN
NANCY – FRANCEATHENES - GREECE
*CHIEF PATRONGLOBAL VASCULAR INSTITUT
HYDERABAD - INDIA
A NEW CONCEPT OF STENT. A NEW CONCEPT OF STENT. THE MULTILAYER STENT. FIRST HUMAN THE MULTILAYER STENT. FIRST HUMAN
STUDY IN PERIPHERAL ANEURYSMSSTUDY IN PERIPHERAL ANEURYSMS
Endovascular Peripheral and Visceral Aneurysms Repair with Cardiatis Multilayer
Stent: Italian Multicenter Preliminary Experience
Ruffino MA* for the Italian CMPS Procedures Registry Group
* Dept. of Vascular and Interventional Radiology
Chief Dr. Claudio RabbiaS. Giovanni Battista Hospital - Turin -
Italy
REGISTRO ITALIANO MULTICENTRICO DELLE PROCEDUREDI ESCLUSIONE DI ANEURISMI E PSEUDOANEURISMI DELLE ARTERIE
PERIFERICHE CON STENT MULTISTRATO
26
M A R SMultilayer Aneurysm Repair System
MULTILAYER STENT : MULTILAYER STENT : 3DIMENSIONAL3DIMENSIONALTECHNOLOGYTECHNOLOGY
Systematic turbulence at normal collateral
Persistance of turbulence with 1 layer stent
Flow alignment with multilayer stent .The
vortex disappears
MULTILAYER STENTEFFECTS ON COLLATERALS
The multilayer design improves inflow into collateral circulation that keeps different size collateral arteries patent.
The multilayer design improves inflow into collateral circulation that keeps different size collateral arteries patent.
Aneurysm size: 55mm Stent 32 mm x 15cm
MULTI LAYER STENTMULTI LAYER STENTTHOR. ABD. ANEURYSMTHOR. ABD. ANEURYSM
Male, 21 Y
Multi-layer bare stents for SMA aneurysm
Intra-sac flow rate decreased after 1st stent Intra-sac flow rate decreased more after 2nd stent
Multi-layer bare stents for SMA aneurysm
Pre-Endo Complete DAS after the 3rd stent
Multi-layer bare stents for SMA aneurysm
Three months follow-up Three months follow-up
Multi-layer bare stents for SMA aneurysm
发现右锁骨上动脉瘤发现右锁骨上动脉瘤 1010 年余年余瘤体大小约瘤体大小约 3.67x2.84cm3.67x2.84cm
Multi-layer bare stents for SCA aneurysm
Multi-layer bare stents for SCA aneurysm
Multi-layer bare stents for SCA aneurysm
Multi-layer bare stents for SCA aneurysm
Pre-Endo Complete DAS after the 3rd stent
Take-home message
Bare stent does have a role in endovascular therapy of branch-artery related aneurysms.
Not only repair the aneurysm, but also keep the branch artery patent.
Three methods: Bare stent assisted coiling Double overlapping bare stents Multi-layer bare stents
Mechanism and long-term outcomes are not clear.
Thank you!
西南血管论坛 -2011
Vascular Symposium Of Southwest China
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