1. 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

2. 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

3. 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:
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

4. Both EVAR & TEVAR were in non-branch-artery related (bare) aorta

5. 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

6. “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

7. But, a lot of branch-artery related aneurysms

8. 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.

9. 1. Bare stent assisted coiling
Concept from intracranial aneurysm embolization

10. 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

11. Bare stent assisted dense coiling
Bare stent assisted coiling for Congenital isolated kidney with a renal artery aneurysm
Bare stent assisted dense coiling

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

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

14. 2. Double overlapping bare stents
Benndorf G, et al. Overlapping stents for treatment of a dissecting carotid artery aneurysm. J Endovasc Ther 2001;8:
Benndorf G, et al. Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 2001;22:
Joseph G, et al. Superimposition of two Wallstents to resolve iatrogenic dissection of an internal carotid artery loop. Indian Heart J 2000;52:
Hyo-Sung Kwak, et al.Treatment of Splenic Artery Aneurysm with Double
Overlapping Bare Stents: Case Report. J Korean Radiol Soc 2004;51:

15. Double overlapping bare stents for iliac aneurysm

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

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

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

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

20. 1st stent Double overlapping bare stents and coils for SMA aneurysm
1st stent with coils
1st stent

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

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

23. 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

24. 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

25. 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

26. 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

27. MULTILAYER STENT : 3DIMENSIONAL TECHNOLOGY27

28. 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

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

30. Multi-layer bare stents for SMA aneurysm
Male, 21 Y

31. Multi-layer bare stents for SMA aneurysm
Intra-sac flow rate decreased after 1st stent
Intra-sac flow rate decreased more after 2nd stent

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

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

34. 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

35. Multi-layer bare stents for SCA aneurysm

36. Multi-layer bare stents for SCA aneurysm

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

38. 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.

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