Figure - available from: Frontiers in Neurology
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(A) Severe stenosis of the left proximal internal carotid artery (ICA) was observed in the digital subtraction angiography (DSA). (B) Revascularization was achieved with balloon and stent angioplasty. (C) DSA showed recurrent left proximal common carotid artery (CCA) occlusion at the 30 months follow-up (red arrow). (D) Intraoperative angiography demonstrated that complementary inflow was reconstituted by collaterals from right lingual branches (red arrow). (E) Another complementary inflow was also reconstituted by collaterals from left occipital branches (red arrow). (F) Carotid endarterectomy (CEA) combined with Fogarty balloon thrombectomy was performed to remove the plaque with a stent, and the stent was seen clearly in the gross specimen. (G) After that, intraoperative angiography in the beginning of CCA showed tandem severe stenosis (green arrow) and dissection (red arrow) at the proximal and median CCA, respectively. (H) Successful recanalization was then achieved with further stent angioplasty with balloon dilation. (I) CT angiography (CTA) indicated the patency of the left CCA at the latest follow-up time (6 months) after hybrid surgery.
Source publication
Background : The hybrid recanalization of internal carotid artery (ICA) and vertebral artery (VA) in-stent restenosis or occlusion using a combination of endarterectomy and endovascular intervention has achieved technical success. We present our surgical experiences to further evaluate the safety and efficacy of the hybrid technique for the treatme...
Citations
... A limitation of this review is that the studies included in this systematic review predominantly included males. This was observed in a study conducted by Wang et al. [39], which included 11 males and 1 female for ET and FAE [39]. A study conducted by Hiramoto et al. [40] analysed the gender-specific risk factors for PAD. ...
... A limitation of this review is that the studies included in this systematic review predominantly included males. This was observed in a study conducted by Wang et al. [39], which included 11 males and 1 female for ET and FAE [39]. A study conducted by Hiramoto et al. [40] analysed the gender-specific risk factors for PAD. ...
Peripheral artery disease is a prevalent illness affecting more than 200 million people worldwide. A commonly used technique to manage the condition has been open endarterectomy. However, in recent times, a shift towards minimally invasive techniques has resulted in endovascular intervention as a popular alternative. This review aims to assess the safety and efficacy of endovascular intervention when compared with endarterectomy. A systematic review of the articles published in PubMed, Ovid, Embase, and Scopus within the last 10 years was conducted. The PRISMA guidelines were adhered to, and the Newcastle-Ottawa and NICE quality assessment scales were used. A meta-analysis of proportions was performed using the RStudio software (RStudio Team (2021). RStudio: Integrated Development Environment for R, PBC, Boston, MA, USA). Twenty-six studies were included, with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). Technical success was greater for endarterectomy than endovascular intervention with an odds ratio of 0.38; 95% CI [0.27–0.54]. In terms of safety as well endovascular intervention was better than endarterectomy with an odds ratio of 0.22; 95% CI [0.15 to 0.31] for wound infection. Endovascular intervention is a safe and effective procedure; however, it cannot be considered superior to endarterectomy.
... A recent study reported using hybrid revascularization technique, a combination of endarterectomy and endovascular intervention technique to treat 12 patients with internal carotid artery and vertebral artery (VA) ISR or occlusion, achieved 100% technical success with acceptable complications. 23 Meanwhile, in our study, we achieved good results with 11 patients with ISR in the VOA using balloon dilation only. For patients with ISR after VAO stenting, the condition in the restenosis segment was more complicated, and it was more difficult to pass the micro guidewire in such situations. ...
Background:
Stenting appears to be a safe means of treatment for vertebral artery ostium stenosis with low complication rates and positive long-term effects, but the incidence of in-stent restenosis (ISR) after stenting is high. Different treatment strategies are applied for the revascularization of ISR; however, currently the optional approach is not recommended. The study was designed to investigate the feasibility, safety, and effectiveness of balloon-assisted angioplasty for the treatment of ISR after vertebral artery ostium stenosis.
Methods:
In this study, we included patients from the Department of Neurology, Lishui Hospital of Zhejiang University, who were treated with balloon-assisted angioplasty as a result of suffering from ISR after previously undergoing vertebral artery ostium stenting. We retrospectively analyzed the clinical and functional outcomes of the patients.
Results:
From January 2015 to December 2019, 11 patients were included in the study. The technical success rate reached 100% and the average operation time was 73 minutes. The Thrombolysis in Cerebral Infarction Score 2b-3 was acquired in all patients except 1 patient, who was presented with symptoms of hypoperfusion syndrome. The remaining 10 patients did not experience any intraoperative or postoperative complications. No restenosis, new cerebral infarction or transient ischemic attack were reported within 6 months of follow-up.
Conclusion:
Balloon-assisted angioplasty could be feasible for the treatment of ISR after vertebral artery ostium stenting, however, more research is needed to confirm this.
