Combined use of covered stent and flow diversion to seal iatrogenic carotid injury with vessel preservation during transsphenoidal endoscopic resection of clival tumor

Hakeem J. Shakir, Alex D. Garson, Grant C. Sorkin, Maxim Mokin, Jorge L. Eller, Travis M Dumont, Saurin R. Popat, Jody Leonardo, Adnan H. Siddiqui

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Methods: We attempted a novel approach combining a covered stent graft (Jostent) and two flow diverter stents [Pipeline embolization devices (PEDs)] to treat active extravasation from a disrupted right ICA that was the result of a transsphenoidal surgery complication. This disruption occurred during clival tumor surgery and required immediate sphenoidal sinus packing. Emergent angiography revealed continued petrous carotid artery extravasation, warranting emergent vessel repair or deconstruction for treatment. To preserve the vessel, we utilized a covered Jostent. Due to tortuosity and lack of optimal wall apposition, there was reduced, yet persistent extravasation from an endoleak after Jostent deployment that failed to resolve despite multiple angioplasties. Therefore, we used PEDs to divert the flow.

Results: Flow diversion relieved the extravasation. The patient remained neurologically intact post-procedure.

Conclusions: This case demonstrates successful combined use of a covered stent and flow diverters to treat acute vascular injury resulting from transsphenoidal surgery. However, concerns remain, including the requirement of dual antiplatelet agents increasing postoperative bleeding risks, stent-related thromboembolic events, and delayed in-stent restenosis rates.

Background: Transsphenoidal tumor resection can lead to internal carotid artery (ICA) injury. Vascular disruption is often treated with emergent vessel deconstruction, incurring complications in a subset of patients with poor collateral circulation and resulting in minor and major ischemic strokes.

Original languageEnglish (US)
Article number133638
JournalSurgical Neurology International
Volume5
DOIs
StatePublished - 2014
Externally publishedYes

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Stents
Wounds and Injuries
Internal Carotid Artery
Neoplasms
Carotid Artery Injuries
Endoleak
Equipment and Supplies
Collateral Circulation
Vascular System Injuries
Platelet Aggregation Inhibitors
Angioplasty
Carotid Arteries
Blood Vessels
Angiography
Stroke
Hemorrhage
Transplants
Therapeutics

Keywords

  • Carotid artery stenting
  • Clival tumor
  • Jostent
  • Pipeline embolization device
  • Transsphenoidal resection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Combined use of covered stent and flow diversion to seal iatrogenic carotid injury with vessel preservation during transsphenoidal endoscopic resection of clival tumor. / Shakir, Hakeem J.; Garson, Alex D.; Sorkin, Grant C.; Mokin, Maxim; Eller, Jorge L.; Dumont, Travis M; Popat, Saurin R.; Leonardo, Jody; Siddiqui, Adnan H.

In: Surgical Neurology International, Vol. 5, 133638, 2014.

Research output: Contribution to journalArticle

Shakir, Hakeem J. ; Garson, Alex D. ; Sorkin, Grant C. ; Mokin, Maxim ; Eller, Jorge L. ; Dumont, Travis M ; Popat, Saurin R. ; Leonardo, Jody ; Siddiqui, Adnan H. / Combined use of covered stent and flow diversion to seal iatrogenic carotid injury with vessel preservation during transsphenoidal endoscopic resection of clival tumor. In: Surgical Neurology International. 2014 ; Vol. 5.
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AU - Shakir, Hakeem J.

AU - Garson, Alex D.

AU - Sorkin, Grant C.

AU - Mokin, Maxim

AU - Eller, Jorge L.

AU - Dumont, Travis M

AU - Popat, Saurin R.

AU - Leonardo, Jody

AU - Siddiqui, Adnan H.

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N2 - Methods: We attempted a novel approach combining a covered stent graft (Jostent) and two flow diverter stents [Pipeline embolization devices (PEDs)] to treat active extravasation from a disrupted right ICA that was the result of a transsphenoidal surgery complication. This disruption occurred during clival tumor surgery and required immediate sphenoidal sinus packing. Emergent angiography revealed continued petrous carotid artery extravasation, warranting emergent vessel repair or deconstruction for treatment. To preserve the vessel, we utilized a covered Jostent. Due to tortuosity and lack of optimal wall apposition, there was reduced, yet persistent extravasation from an endoleak after Jostent deployment that failed to resolve despite multiple angioplasties. Therefore, we used PEDs to divert the flow.Results: Flow diversion relieved the extravasation. The patient remained neurologically intact post-procedure.Conclusions: This case demonstrates successful combined use of a covered stent and flow diverters to treat acute vascular injury resulting from transsphenoidal surgery. However, concerns remain, including the requirement of dual antiplatelet agents increasing postoperative bleeding risks, stent-related thromboembolic events, and delayed in-stent restenosis rates.Background: Transsphenoidal tumor resection can lead to internal carotid artery (ICA) injury. Vascular disruption is often treated with emergent vessel deconstruction, incurring complications in a subset of patients with poor collateral circulation and resulting in minor and major ischemic strokes.

AB - Methods: We attempted a novel approach combining a covered stent graft (Jostent) and two flow diverter stents [Pipeline embolization devices (PEDs)] to treat active extravasation from a disrupted right ICA that was the result of a transsphenoidal surgery complication. This disruption occurred during clival tumor surgery and required immediate sphenoidal sinus packing. Emergent angiography revealed continued petrous carotid artery extravasation, warranting emergent vessel repair or deconstruction for treatment. To preserve the vessel, we utilized a covered Jostent. Due to tortuosity and lack of optimal wall apposition, there was reduced, yet persistent extravasation from an endoleak after Jostent deployment that failed to resolve despite multiple angioplasties. Therefore, we used PEDs to divert the flow.Results: Flow diversion relieved the extravasation. The patient remained neurologically intact post-procedure.Conclusions: This case demonstrates successful combined use of a covered stent and flow diverters to treat acute vascular injury resulting from transsphenoidal surgery. However, concerns remain, including the requirement of dual antiplatelet agents increasing postoperative bleeding risks, stent-related thromboembolic events, and delayed in-stent restenosis rates.Background: Transsphenoidal tumor resection can lead to internal carotid artery (ICA) injury. Vascular disruption is often treated with emergent vessel deconstruction, incurring complications in a subset of patients with poor collateral circulation and resulting in minor and major ischemic strokes.

KW - Carotid artery stenting

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