Hybrid Interventions in the Case of Combined Stenosis of the Carotid Bifurcations and Supra-Aortic Arteries

• Published in: Journal of stroke and cerebrovascular diseases Vol. 25; no. 1; pp. 63 - 66
• Main Authors: Starodubtsev, Vladimir, Karpenko, Andrey, Ignatenko, Pavel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Aged; Angioplasty; Aorta, Thoracic - surgery; Brachiocephalic Trunk - surgery; Cardiovascular; Carotid artery; Carotid Artery, Common - surgery; Carotid Artery, Internal - surgery; carotid bifurcations; carotid endarterectomy; Carotid Stenosis - complications; Carotid Stenosis - surgery; Carotid Stenosis - therapy; Endarterectomy, Carotid - methods; Female; Follow-Up Studies; Humans; hybrid procedure; Hypertension - complications; Male; Middle Aged; Neurology; Polyethylene Terephthalates; Prospective Studies; Prostheses and Implants; Stents; supra-aortic arteries; tandem lesions; Treatment Outcome; tandem lesions; carotid endarterectomy; Carotid artery; supra-aortic arteries; carotid bifurcations; hybrid procedure
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.034

The purpose of our study is to describe the technique, safety, and efficacy of hybrid carotid revascularization for the treatment of combined occlusive lesions of the carotid bifurcations and supra-aortic arteries. We monitored the results of hybrid surgical interventions including carotid endarterectomy (CEA) and stenting either the common carotid artery (CCA) or the brachiocephalic trunk (BCT) in 12 patients. Nine men and 3 women with occlusive atherosclerosis made up the cohort. All surgical interventions were performed with local anesthesia by means of standard operative access to the bifurcation of the carotid artery. After the correction of the proximal stenosis of the CCA or BCT with subsequent angiography, the CEA was performed. The mean follow-up was 33.5 months (range, 6-48). Ten patients underwent left CCA stenting in combination with CEA. Among the 10 patients, CEA was performed using the eversion technique in 5 cases and patch angioplasty in the other 5 cases. In the remaining 2 cases, the patients underwent CEA with patch angioplasty of the right internal carotid artery in combination with stenting of the BCT critical stenosis. During the early postoperative period and follow-up to 48 months, a stroke was not registered. Hybrid interventions (CEA and stenting of the CCA or BCT) allow combination of the advantages of each method in the treatment of multilevel vascular disease. This study confirms the safety and efficacy of hybrid interventions in a small cohort of patients while emphasizing the need for future randomized controlled trials in larger populations.