endovascular repair of branch-artery adjacent aneurysm using bare stents – preliminary experience...

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


One-year follow up


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


Deployment of 1st stent DSA after 1st stent


Deployment of 2nd stent DSA after 2nd stent

Pre-Endo Post-Endo


Double overlapping bare stents and coils for SMA aneurysm

Pre-Endo Pre-Endo


1st stent 1st stent with coils


Pre-Endo Two stents with coils


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


Pre-Endo Complete DAS after the 3rd stent


Three months follow-up Three months follow-up


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


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

endovascular repair of branch-artery adjacent aneurysm using bare stents – preliminary experience...

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