Safety and outcomes of self-expanding covered stents in carotid revascularization for Shamblin class III carotid body tumors.

Abstract

A carotid body tumor (CBT) located near the skull base presents considerable challenges for revascularization. This study presents a 15-year experience using a novel sutureless anastomotic technique for carotid artery revascularization, aimed at minimizing blood flow interruption and reducing the risk of cerebral ischemia. This multicenter retrospective cohort study included patients with Shamblin class III CBTs who underwent tumor excision and carotid revascularization (CR) at three medical centers. Patients were categorized based on the technique used: traditional CR with artificial or saphenous vascular graft and CR with self-expanded covered stents. Patients were monitored through follow-up evaluations over a 1-year period. The primary end point was defined as graft occlusion within 1-year after surgery. Secondary end points encompassed recurrence of CBT, temporary and persistent cranial nerve damage (CND), and stroke. There were 93 Shamblin class III CBT patients included during a mean follow-up time of 2.35 years. In comparison with the CR with artificial or saphenous vascular graft group (n = 57), the CR with self-expanded covered stents group (n = 36) demonstrated a statistically significant reduction in operation duration (P < .001), intraoperative blood flow interruption time (P < .001), incidence of temporary CND symptoms (P = .002), and rate of persistent CND (P < .001). Additionally, there was a statistically significant increase in graft patency (P = .003). Our study demonstrated the safety, rapid revascularization, and favorable patient outcomes of this novel technique. Long-term observation is warranted to prove the durability.