Aortic Arch Stenting Found Viable and Safe

A new study has found that endoluminal stenting of a stenotic aortic arch vessel with adequate cerebral protection may be a viable alternative to traditional open bypass surgery.

Researchers at Northwestern University (Evanston, IL, USA) retrospectively reviewed results of stenting in 20 brachiocephalic-origin vessels in 18 patients, with a mean age of 68 years. Mean stenosis was 85%, and target lesions were in the innominate, the common carotid, or the subclavian arteries. Pre-procedural symptoms including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 16 of 20 cases (80%). The four asymptomatic patients all had more than 90% stenosis on angiography. At 30-day follow-up, there were no deaths, myocardial infarctions, or strokes. During follow-up, there were no cases of restenosis.

The researchers used stents sized between 6 and 7 mm in diameter, compared with an average of 2.0 to 2.5 mm diameter in coronary artery stenting. The balloon-expandable stents were placed via the femoral or brachial artery, or a cut-down on the common carotid artery. In most cases, cerebral protection was achieved with a distal embolic filter or with surgical closure of the distal common carotid artery. The study was reported in the June 2006 issue of Archives of Surgery.

"The only contraindication for stenting of the aortic vessels is if they're completely blocked,” said lead author Dr. Mark K. Eskandari. "In those cases, we can't snake a wire or a balloon through the stenosis; that would really increase risk of stroke.”

Traditional management of supra-aortic trunk disease has employed surgical extra-anatomic bypass via a cervical approach or median sternotomy. The researchers suggested that endoluminal therapy may be a less morbid alternative, but that follow-up care is the same as in a patient with coronary artery disease, with lipid-lowering agents and other medications and measures used to reduce risk.



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