Novel use of the Solitaire AB re-deployable stent for exclusion ......• 6mm by 3 cm Solitaire©...
Transcript of Novel use of the Solitaire AB re-deployable stent for exclusion ......• 6mm by 3 cm Solitaire©...
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Novel use of the Solitaire© AB re-deployable stent for exclusion of wide
neck peri-hilar Renal Artery Aneurysms (RAAs)
Khawaja AZ1, Inston NG1, Lipkin G2, Jones RG3
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Disclosure
Speaker name: Aurang Zaib Khawaja
.................................................................................
I do not have any potential conflict of interest x
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Background • Low incidence, ~70% asymptomatic, incidental finding
• Indications for repair: limited evidence, interpretable
• Common ethiology: FMD, ATS, Vasculitis, Trauma
• Treatment strategies: Surgical in-vivo/ex-vivo, embolisation, stents, endografts, combination therapy
• Complex cases: risk of parenchymal infarction, nephrectomy
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Case 1 • 55 yr old hypertensive female
• Incidental finding
• 2.5 cm wide neck saccular Right RAA
• Multidisciplinary review, informed consent
• 7 French Destination©* renal double curve shaped sheath *Terumo Interventional Systems, Surrey, UK
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Technique • Separate micro catheter placed in
main body
• Selective catheterization of upper pole branch
• 6mm by 3 cm Solitaire© AB* positioned/repositioned
* Covidien, eV3 Intl, Herts, UK
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Technique • Embolization coils deployed via
selective micro catheter
• Stent then detached in a satisfactory position
• Completion angiography: • successful exclusion • preservation of both arteries
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Post Procedure • No major or minor complications
• Dual antiplatelet for 6 weeks - life-long aspirin
• 3 months post procedure : 2 antihypertensives stopped & eGFR 74
• Follow up MRA at 60 days • patent renal vessels • minor proximal filling but vast majority of
aneurysm excluded
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Case 2 • 55 yr old female - FMD
• Incidental finding
• Multidisciplinary review
• 2 cm dumbbell shaped aneurysm at bifurcation of main renal
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Technique • A 6Fr Chariot© shapeable
sheath
• 6mm by 3 cm Solitaire© AB* positioned/repositioned & deployed
• Aneurysm catheterised via same access sheath
* Boston Scientific, Herts, UK
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Technique • Multiple detachable embolization coils
deployed via selective micro catheter
• Stent detached in a satisfactory position
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Post Procedure • Completion angiography:
• successful exclusion • preservation of both upper & lower pole
arteries
• No other major or minor procedure related complications
• Follow up at 60 days normotensive and eGFR 79
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Discussion • Elective open & endovascular repair reported equivalent
• Surgical opinion - complex, higher risk
• Endovascular opinion - incomplete exclusion, parenchymal loss
• Indication for repair - symptomatic, patient preference
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Conclusion • Solitaire© AB stent – novel use in management of RAA
• Adequate positioning/repositioning
• Optimal radial force for flexibility in tortuous anatomy & coil mass support
• Multidisciplinary approach for complex cases
• Safe & efficacious in combined management of wide-neck RAAs