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eComment: Everyday clinical practice consequences?

University Hospital, Bugnon 46, 1011 Lausanne, Switzerland

Type A aortic dissection involving the carotid arteries: carotid stenting during open aortic arch surgery

This report by Lentini et al. [1] raises some interesting issues like the indication to stent, its eventual necessity for stroke prevention to avoid treating ‘images’ and the real long-term patency.

Nowadays, published studies on stenting in dissected precerebral arteries are all retrospective and non-randomized, summarizing experiences on about 200 patients. Stenting was performed acutely to open a stenosis or seal an intimal flap, and chronically to exclude a pseudoaneurysm. A relatively high technical success was reported with a failure rate of 5% and few perioperative complications.

However, the efficacy of stenting – and whether it is even necessary in many cases – remains uncertain. Many stenotic lesions, following dissection, spontaneously recanalise. A recent study [2] even suggested that the risk of recurrent embolization from pseudoaneurysm in dissection is very low. Therefore, for all these reasons, the widespread use of stenting in dissection in our everyday clinical practice and its efficacy should be assessed in randomized trials.

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1. Lentini S, Tancredi F, Benedetto F, Gaeta R. Type A aortic dissection involving the carotid arteries: carotid stenting during open aortic arch surgery. Interact CardioVasc Thorac Surg 2009;8:157–159.[Abstract/Free Full Text]
2. Guillon B, Brunereau L, Biousse V, Djouhri H, Lévy C, Bousser MG. Long-term follow-up of aneurysms developed during extracranial internal carotid dissection. Neurology 1999;53:117–122.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Patrick Ruchat Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ruchat, P. Search for Related Content PubMed PubMed Citation Articles by Ruchat, P. Related Collections Related Article