Double Stent Technique for the Treatment of an Internal Carotid Artery Pseudoaneurysm Caused by Zone III Stab Injury

Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review

BACKGROUND

The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases.

METHODS

The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration.

RESULTS

Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P = 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P = 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P = 0.001).

CONCLUSIONS

In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.

Endovascular Treatment of 2 Synchronous Extracranial Carotid Artery Aneurysms Using Stent-Assisted Coil Embolization and Double Bare-Metal Stenting

Extracranial carotid artery aneurysms located in the cervical region in close proximity to the skull are difficult to access using open surgical methods. Endovascular treatment has emerged as an alternative option for anatomically challenging internal carotid artery aneurysms. However, data comparing various endovascular techniques including stent grafting, coil embolization, double stenting, and stent-assisted coil embolization are lacking, making it difficult to determine the optimal treatment. We present a case of a patient with 2 fusiform extracranial carotid artery aneurysms treated successfully with a combination of double stenting and stent-assisted coil embolization. We also discuss technical considerations for selecting the appropriate endovascular intervention.

Endovascular treatment of a patient with an aneurysm of the proper hepatic artery and a duodenal fistula

Aneurysms of the proper hepatic artery comprise a rare but potentially dangerous entity for which treatment is performed both surgically and endovascularly. Covered stents are generally used for endovascular treatment of such aneurysms. When the aneurysm is contaminated due to an enteric fistula, however, use of a covered stent is considered inappropriate. This case report describes the endovascular repair of a proper hepatic artery aneurysm using overlapping bare metal stents after the patient was surgically treated for duodenal hemorrhage.

Traumatic internal carotid artery injury treated with overlapping bare metal stents under intravascular ultrasound guidance

We report a case of traumatic internal carotid artery pseudoaneurysm near the skull base that was successfully treated with anticoagulation and antiplatelet therapy and two overlapping bare stents placed under intravascular ultrasound guidance. Although incomplete exclusion of the pseudoaneurysm was seen on completion angiography, follow-up computed tomography angiography revealed complete resolution of the treated lesion. The patient remains asymptomatic at the 18-month clinical follow-up. This case report illustrates a successful endovascular treatment of a complex traumatic pseudoaneurysm with bare metal stenting using intravascular ultrasound guidance.