Department of Vascular Surgery， Changhai Hospital, Shanghai, China

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Presentation transcript:

Department of Vascular Surgery， Changhai Hospital, Shanghai, China 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 Endovascular Aortic Aneurysm Repair EVAR J.C. Parodi Parodi’s initial EVAR device in 1990 First English language-publication by Juan Parodi et al in 19911 1 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491-9 2

The first English-language report by Dake et al in 19941 Initiation of TEVAR in 1992 Thoracic Endovascular Aortic Repair TEVAR The first English-language report by Dake et al in 19941 N Engl J Med 1994;331:1729-34 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 !! 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 reasons Sufficient landing zones for both proximal and distal anchoring parts No interferences of blood supply for the adjacent organs

“3N3V” Classification: Special for EVAR & TEVAR 主动脉分为: 3个“裸区”（Nude） 3个“血管区”(Visceral) N1升主动脉区和V2主动脉弓区的亚分区 A

But, a lot of branch-artery related aneurysms

Is there a simple, safe and effective way ? Current solutions Is there a simple, safe and effective way ? Fenestrated or branched stent graft Debranching techniques hybrid with endovascular procedures Yes. Bare Stents.

1. Bare stent assisted coiling Concept from intracranial aneurysm embolization

A 46-year-old man, single right kidney with a giant aneurysm 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 Bare stent assisted coiling for Congenital isolated kidney with a renal artery aneurysm Bare stent assisted dense coiling

Bare stent assisted coiling for Congenital isolated kidney with a renal artery aneurysm One-year follow up

Bare stent assisted coiling for Congenital isolated kidney with a renal artery aneurysm One-year follow up

2. Double overlapping bare stents 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 Hyo-Sung Kwak, et al.Treatment of Splenic Artery Aneurysm with Double Overlapping Bare Stents: Case Report. J Korean Radiol Soc 2004;51:291-294

Double overlapping bare stents for iliac aneurysm

Double overlapping bare stents for iliac aneurysm Deployment of 1st stent DSA after 1st stent

Double overlapping bare stents for iliac aneurysm Deployment of 2nd stent DSA after 2nd stent

Double overlapping bare stents for iliac aneurysm Post-Endo Pre-Endo

Double overlapping bare stents and coils for SMA aneurysm Pre-Endo Pre-Endo

1st stent Double overlapping bare stents and coils for SMA aneurysm 1st stent with coils 1st stent

Double overlapping bare stents and coils for SMA aneurysm Pre-Endo Two stents with coils

Double overlapping bare stents and coils for SMA aneurysm Two weeks follow-up Two weeks follow-up

3. Multi-layer bare stents MICHAEL. HENRY* MD, F.A.H.A., F.A.C.A. ,F.E.S.C., F.A.S.A., F.I.C.I.C. INTERVENTIONAL CARDIOLOGIST Ruffino MA* for the Italian CMPS Procedures Registry Group Presented at Endovascology 2009, Shanghai Presented at CIRSE 2010, Valencia, Spain

A NEW CONCEPT OF STENT. THE MULTILAYER STENT A NEW CONCEPT OF STENT. THE MULTILAYER STENT. FIRST HUMAN STUDY IN PERIPHERAL ANEURYSMS M. HENRY* MD, F.A.H.A., F.A.C.A. ,F.E.S.C., F.A.S.A., F.I.C.I.C. INTERVENTIONAL CARDIOLOGIST A.POLYDOROU MD, A. BENJELLOUN , I. HENRY MD , M. HUGEL RN NANCY – FRANCE ATHENES - GREECE *CHIEF PATRON GLOBAL VASCULAR INSTITUT HYDERABAD - INDIA

REGISTRO ITALIANO MULTICENTRICO DELLE PROCEDURE DI ESCLUSIONE DI ANEURISMI E PSEUDOANEURISMI DELLE ARTERIE PERIFERICHE CON STENT MULTISTRATO 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 Rabbia S. Giovanni Battista Hospital - Turin - Italy 25

Multilayer Aneurysm Repair System M A R S Multilayer Aneurysm Repair System Pourquoi c’est changement de Paradigm? Parceque le stent ferme les anévrismes sans couverture Dacron ou PTFE. Aussi il prévient l’hyperplasie d’après les premières constatations chez l’animal et chez l’homme (5mois) 26 26

MULTILAYER STENT : 3DIMENSIONAL TECHNOLOGY 27

MULTILAYER STENT EFFECTS ON COLLATERALS Flow alignment with multilayer stent .The vortex disappears Systematic turbulence at normal collateral Persistance of turbulence with 1 layer stent L’image à gauche, sans stent, montre qu’il y a une recirculation à l’entrée de la barnche ( d’où le dépôt d’athérome habituel à l’ostium, comme dans le cas des rénales) . La 2ième image montre un stent monocouche où la Re-circulation persiste. La 3ième image le stent multicouches aligne le lignes de flux. The multilayer design improves inflow into collateral circulation that keeps different size collateral arteries patent. 28

MULTI LAYER STENT THOR. ABD. ANEURYSM Aneurysm size: 55mm Stent 32 mm x 15cm

Multi-layer bare stents for SMA 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

Complete DAS after the 3rd stent Multi-layer bare stents for SMA aneurysm Pre-Endo Complete DAS after the 3rd stent

Three months follow-up Three months follow-up Multi-layer bare stents for SMA aneurysm Three months follow-up Three months follow-up

Multi-layer bare stents for SCA aneurysm 发现右锁骨上动脉瘤10年余瘤体大小约3.67x2.84cm

Multi-layer bare stents for SCA aneurysm

Multi-layer bare stents for SCA aneurysm

Complete DAS after the 3rd stent 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.

Vascular Symposium Of Southwest China 西南血管论坛-2011 Vascular Symposium Of Southwest China Thank you! 1