Effect analysis of Wallstent combined with flow diverter in treatment of long extracranial segment dissection of internal carotid artery
Objective To evaluate the efficacy and safety of Wallstent combined with flow diverter(FD)in treatment of long extracranial dissection of the internal carotid artery.Methods A retrospective analysis on clinical and imaging data of patients with long extracranial carotid artery dissection treated with Wallstent combined with FD in the Department of Interventional Radiology of the First Affiliated Hospital of Zhengzhou University from March 2021 to June 2023.The efficacy and safety of the operation were evaluated according to the results of immediate postoperative angiography,perioperative complications,postoperative symptom improvement and the follow-up results.Results Fourteen patients met the enrollment criteria and were enrolled into this study,including 5 patients with dissecting aneurysm and 9 patients with simple arterial dissection.In all patients,one Wallstent and one Tubridge FD were sequentially implanted at the dissection lesions with partial overlap of stents,and the technical success rate was 14/14.Immediate postoperative angiography showed that all stents were well attached,and obvious contrast agent retention was observed in 5 dissecting aneurysms,and lumen blood flow was restored in 9 patients with simple dissection lesions.No serious complications such as acute stent thrombosis,blood vessel rupture,and bleeding were observed during perioperative period.All patients received clinical follow-up for 3 to 19 months,with an average follow-up time of 10.14±1.18 months.One patient developed contralateral limb weakness(muscle strength grade Ⅲ)at 11 months after surgery,and CT angiography(CTA)indicated intrastent luminal occlusion.Muscle strength returned to normal after treatment with drugs such as antiplatelet and dilatancy,with no residual limb movement disorder.No new neurological symptoms or signs were found in the remaining 13 patients at the last follow-up.Postoperative imaging follow-up was obtained for 13 patients,including 6 cases of digital subtraction angiography(DSA)and 7 cases of CTA.The follow-up time[M(Q1,Q3)]was 8(6,9)months.In addition to 1 patient with intrastent occlusion,the remaining 12 patients showed complete aneurysm occlusion(4 cases)or disappearance of dissection lesion(8 cases)while the carrying artery remained unobstructed.Conclusions Wallstent combined with FD implantation is a safe and effective treatment for long extracranial intersectional dissection of internal carotid artery.However,due attention should be paid to the occurrence of chronic intrastent occlusion after surgery.
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