Multiple multilayer stents for thoracoabdominal aortic aneurysm: a possible new tool for aortic endovascular surgery

Valerio Stefano Tolva,1,3 Paolo Guy Bianchi,1 Lea Valeria Cireni,1 Alma Lombardo,1 Guido Carlo Keller,1 Gianfranco Parati,2,3 Renato Maria Casana11Surgical Department Istituto Auxologico Italiano IRCCS, Milan, Italy; 2Department of Cardiology, Istituto Auxologico Italiano, Università degli Studi di Milano-Bicocca, Bicocca, Milan, Italy; 3Department of Internal Medicine, San Gerardo Hospital, Università degli Studi di Milano-Bicocca, Bicocca, Milan, ItalyPurpose: Endovascular surgery data are confirming the paramount role of modern endovascular tools for a safe and sure exclusion of thoracoabdominal lesions.Case report: A 57-year-old female presented with severe comorbidity affected by a 58 mm thoracoabdominal aortic aneurysm (TAAA). After patient-informed consent and local Ethical Committee and Italian Public Health Ministry authorization, three multilayer stents were implanted in the thoracoabdominal aortic tract, obtaining at a 20-month computed tomography scan follow up, a complete exclusion of the TAAA, with normal patency of visceral vessels.Conclusion: Multilayer stents can be used in thoracoabdominal aortic aneurysm, with positive results.Keywords: chimney technique, renal artery stenosis, thoracoabdominal aneurysm, vascular complicatio

Carotid artery stenting in patients with acute coronary syndrome: a possible primary therapy for symptomatic carotid stenosis

PURPOSE: To report the results of carotid artery stenting (CAS) in symptomatic patients (stroke/transient ischemic attack) after recent percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS). METHODS: Between January 2009 and July 2011, 28 consecutive patients (18 women; mean age 66 years, range 42-82) underwent protected CAS for symptomatic carotid stenosis following recent PTCA that included bare or drug-eluting stents requiring uninterrupted dual antiplatelet therapy. Primary technical success, neurological complications, major adverse cardiovascular events, and death were evaluated at 30 days and over midterm follow-up. RESULTS: Technical success was 96%; 1 patient suffered a nonfatal major stroke (3.5% 30-day stroke rate) during the procedure. During a median 21.6-month follow-up, 4 (14%) patients died of myocardial infarction (all diabetic smokers with ejection fractions <40%), but there were no new neurological events. Estimated survival was 89.3% at 2 years. Further coronary interventions were performed in 2 diabetic patients with a body mass index >34 kg/m(2). CONCLUSION: This preliminary experience demonstrated that CAS is a reasonable, safe, and effective treatment for patients with symptomatic carotid artery stenosis who were recently treated with coronary stents requiring uninterrupted dual antiplatelet therapy