Stenting of the Great Vessels

  • John F. Morrison
  • Hakeem J. Shakir
  • Jason M. Davies
  • Elad I. LevyEmail author


Endovascular treatment of pathologies of the great vessels leading to the cerebrovasculature is becoming increasingly common. This is achieved by use of stents to reinforce an injured vessel lumen or expand the lumen in stenotic segments. Here we discuss the indication for stenting, types of stents available, and associated complications from these procedures and their management.


Carotid artery stenting Vertebral artery stenting Subclavian artery stenting 



Carotid artery stenting


Common carotid artery


Carotid endarterectomy


Computed tomographic angiogram or angiography


Digital subtraction angiography


External carotid artery


French [scale]


Internal carotid artery


Intravascular ultrasound


National Institutes of Health Stroke Scale


  1. 1.
    Inamasu J, Guiot BH. Iatrogenic carotid artery injury in neurosurgery. Neurosurg Rev. 2005;28(4):239–47. Discussion 248.CrossRefPubMedGoogle Scholar
  2. 2.
    Inamasu J, Guiot BH. Iatrogenic vertebral artery injury. Acta Neurol Scand. 2005;112(6):349–57.CrossRefPubMedGoogle Scholar
  3. 3.
    Brott TG, Hobson RW II, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF, CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363(1):11–23.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Faggioli G, Ferri M, Rapezzi C, Tonon C, Manzoli L, Stella A. Atherosclerotic aortic lesions increase the risk of cerebral embolism during carotid stenting in patients with complex aortic arch anatomy. J Vasc Surg. 2009;49(1):80–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Fanous AA, Natarajan SK, Jowdy PK, Dumont TM, Mokin M, Yu J, Goldstein A, Wach MM, Budny JL, Hopkins LN, Snyder KV, Siddiqui AH, Levy EI. High-risk factors in symptomatic patients undergoing carotid artery stenting with distal protection: Buffalo Risk Assessment Scale (BRASS). Neurosurgery. 2015;77(4):531–42. Discussion 542–533.CrossRefPubMedGoogle Scholar
  6. 6.
    Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG, CREST Investigators. The carotid revascularization endarterectomy versus stenting trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke. 2010;41(10 Suppl):S31–4.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sullivan TM, Gray BH, Bacharach JM, Perl J II, Childs MB, Modzelewski L, Beven EG. Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients. J Vasc Surg. 1998;28(6):1059–65.CrossRefPubMedGoogle Scholar
  8. 8.
    De Vries JP, Jager LC, Van den Berg JC, Overtoom TT, Ackerstaff RG, Van de Pavoordt ED, Moll FL. Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. J Vasc Surg. 2005;41(1):19–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Brountzos EN, Petersen B, Binkert C, Panagiotou I, Kaufman JA. Primary stenting of subclavian and innominate artery occlusive disease: a single center’s experience. Cardiovasc Intervent Radiol. 2004;27(6):616–23.CrossRefPubMedGoogle Scholar
  10. 10.
    Chang FC, Luo CB, Lirng JF, Lin CJ, Lee HJ, Wu CC, Hung SC, Guo WY. Endovascular management of post-irradiated carotid blowout syndrome. PLoS One. 2015;10(10):e0139821.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cohen J, Rad I. Contemporary management of carotid blowout. Curr Opin Otolaryngol Head Neck Surg. 2004;12(2):110–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Chang FC, Lirng JF, Luo CB, Guo WY, Teng MM, Tai SK, Chang CY. Carotid blowout syndrome in patients with head-and-neck cancers: reconstructive management by self-expandable stent-grafts. AJNR Am J Neuroradiol. 2007;28(1):181–8.PubMedGoogle Scholar
  13. 13.
    Hershberger RC, Aulivola B, Murphy M, Luchette FA. Endovascular grafts for treatment of traumatic injury to the aortic arch and great vessels. J Trauma. 2009;67(3):660–71.CrossRefPubMedGoogle Scholar
  14. 14.
    Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47(5):845–53.CrossRefPubMedGoogle Scholar
  15. 15.
    Duane TM, Parker F, Stokes GK, Parent FN, Britt LD. Endovascular carotid stenting after trauma. J Trauma. 2002;52(1):149–53.PubMedGoogle Scholar
  16. 16.
    Maras D, Lioupis C, Magoufis G, Tsamopoulos N, Moulakakis K, Andrikopoulos V. Covered stent-graft treatment of traumatic internal carotid artery pseudoaneurysms: a review. Cardiovasc Intervent Radiol. 2006;29(6):958–68.CrossRefPubMedGoogle Scholar
  17. 17.
    Jolly SS, Niemela K, Xavier D, Widimsky P, Budaj A, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Cairns J, Chrolavicius S, Yusuf S, Mehta SR. Design and rationale of the radial versus femoral access for coronary intervention (RIVAL) trial: a randomized comparison of radial versus femoral access for coronary angiography or intervention in patients with acute coronary syndromes. Am Heart J. 2011;161(2):254–60. e251–254.CrossRefPubMedGoogle Scholar
  18. 18.
    Mendiz OA, Fava C, Lev G, Caponi G, Valdivieso L. Transradial versus transfemoral carotid artery stenting: a 16-year single-center experience. J Interv Cardiol. 2016;29(6):588–93.CrossRefPubMedGoogle Scholar
  19. 19.
    O’Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis. Crit Care Med. 2014;42(6):1334–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Dumont TM, Kan P, Snyder KV, Hopkins LN, Levy EI, Siddiqui AH. Stenting of the vertebral artery origin with ostium dilation: technical note. J Neurointerv Surg. 2013;5(5):e36.CrossRefPubMedGoogle Scholar
  21. 21.
    Rangel-Castilla L, Gandhi S, Munich SA, Cress MC, Sonig A, Krishna C, Hopkins LN, Snyder KV, Levy EI, Siddiqui AH. Experience with vertebral artery origin stenting and ostium dilatation: results of treatment and clinical outcomes. J Neurointerv Surg. 2016;8(5):476–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Kadkhodayan Y, Derdeyn CP, Cross DT III, Moran CJ. Procedure complications of carotid angioplasty and stent placement without cerebral protection devices. Neurosurg Focus. 2005;18(1):e1.CrossRefPubMedGoogle Scholar
  23. 23.
    Tang X, Long WA, Hu C, Tang F, Wang Q, Li L. The modified ‘no touch’ technique in the antegrade endovascular approach for left common carotid artery ostial stenosis stenting. J Neurointerv Surg. 2017;9(2):137–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Salman R, Hornsby J, Wright LJ, Elsaid T, Timmons G, Mudawi A, Bhattacharya V. Treatment of subclavian artery stenosis: a case series. Int J Surg Case Rep. 2016;19(Jan):69–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • John F. Morrison
    • 1
    • 2
  • Hakeem J. Shakir
    • 1
    • 2
  • Jason M. Davies
    • 1
    • 2
    • 3
  • Elad I. Levy
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  1. 1.Department of Neurosurgery, Jacobs School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA
  2. 2.Gates Vascular Institute at Kaleida HealthBuffaloUSA
  3. 3.Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA
  4. 4.Department of Radiology, Jacobs School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA
  5. 5.Toshiba Stroke and Vascular Research CenterBuffaloUSA

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