Endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases using Willis covered stent

Abstract

Background: To report the clinical results and experiences of endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases (ICAVDs) using Willis covered stents. METHODS: Seventy-three patients with ICAVD who received Willis covered stent implantation between November 2013 and September 2018 were retrospectively reviewed. The clinical data of endoleak management and postoperative surveillance were analyzed. RESULTS: Seventy-three cases with ICAVD, including 57 aneurysms, 11 carotid-cavernous sinus fistulas (CCF), and 5 surgical injuries, were all successfully installed with covered stents. Total isolation of ICAVDs was achieved in 59 patients (80.8%), and endoleaks were observed in 14 patients (19.2%). Of the 14 patients with endoleaks, 12 had type I endoleaks and 2 had type II; 13 had aneurysms and one had CCF. 10 patients with type I endoleaks received balloon dilatation, and 7 of them underwent a second stent-graft implantation after then. One patient with type II endoleak received embolization of the branch artery, and another one received follow-up observation. Endoleaks resolved in 6 patients and were minimal in 5 patients after balloon dilatation or the second stent implantation. During the follow-up period, minor endoleaks spontaneously resolved in 4 patients and minimal endoleaks were still demonstrated in 4 patients without enlargement of residual lumen and rupture. CONCLUSIONS: Endoleaks are the major complication after endovascular repair of ICAVDs and represent one of the limitations of this procedure. Improving the understanding and management of endoleaks can be beneficial in the clinical setting, including the popularization and application of this technique.

Keywords

• Covered stent
• Endovascular repair
• Internal carotid artery
• Endoleak