262 An attractive endovascular strategy for combined—aneurysmal and stenotic—coronary artery disease

In patients undergoing coronary angiography the coexistence of aneurysmal and stenotic lesions in adjacent segments of the same epicardial vessel is uncommon. We describe a rare case of single-vessel coronary artery disease (CAD) in a 70-year-old male, presenting with progressive effort-induced angina of 3-months’ evolution. The coronary angiogram revealed a critical calcified stenosis in the context of diffuse ectasia affecting the right coronary artery (RCA). Our report focuses on a complex revascularization procedure using the self-expandable Carotid Wallstent. Highlighting the importance of a multidisciplinary approach, we provide an original and effective endovascular solution for an unusual pathological angiographic finding, which could be of potential interest for interventional cardiologists.

Endovascular treatment of the vertebral artery origin stenosis by using the closed-cell, self-expandable Carotid Wallstent

Background Endovascular treatment has been considered a good alternative to surgery for symptomatic vertebral artery origin stenosis (VAOS) due to the high risk of morbidity associated with surgery. The purpose of this study was to evaluate the feasibility and efficacy of insertion of the closed-cell, self-expandable Carotid Wallstent for the treatment of VAOS. Methods The records of 72 patients with VAOS refractory to adequate medication who were treated by endovascular treatment with the Carotid Wallstent from December 2006 to November 2018 were retrospectively evaluated. Results Of the 72 patients, 43 presented with transient ischemic attacks. Forty-seven patients (65.3%) manifested other brachiocephalic stenoses; of these, 40 patients had occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Overall technical success (defined as 20% or less residual stenosis) was 100%. Procedure-related complications ( n = 8, 11.1%) included sudden asystole ( n = 1), acute in-stent thrombosis ( n = 3), minor stroke ( n = 3), and stent shortening ( n = 1). All complications were resolved without permanent neurological deficit. Angiographic follow-up (mean, 13.0 months) was achieved in 49 patients and revealed in-stent restenosis in 1 patient (2.0%) and stent malposition by shortening in 2 patients (4.1%). Follow-up records were available in 57 patients (mean 15.6 months). Three of the 57 patients ( n = 3, 5.3%) had recurrent symptoms of vertebrobasilar ischemia and none was retreated. Conclusions Endovascular treatment of symptomatic VAOS using the closed-cell, self-expandable Carotid Wallstent is technically feasible and effective in alleviating patient symptoms and for improving vertebrobasilar blood flow.

Endovascular Treatment for Bilateral Carotid Stenosis: a Case Report

Carotid artery stenosis is usually a consequence of thromboembolism or atheroembolism, or it can be secondary to a low-velocity status in the carotid circulation. This disease can also represent an important cause of stroke, being responsible for 7% of all stroke cases. Endovascular techniques were recently proposed as alternative interventions for patients with high risk for endarterectomy. We present the case of a 70-year-old patient, accusing headache, vertigo, and fatigue. Angiography indicated bilateral carotid artery stenosis. Interventional surgery and angioplasty were performed, crossing the stenotic lesions of the left internal carotid artery, followed by the implantation of a Carotid WALLSTENT endoprosthesis. Evolution of the patient was favorable after the endovascular intervention, with significant improvement of the symptoms caused by bilateral carotid stenosis. As a conclusion, decision-making must be modulated in each patient, according to the patient’s anatomy and comorbidities, and the experience of the team performing the procedure.