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Cornwall JW, Png CYM, Han DK, Tadros RO, Marin ML, Faries PL. Endovascular techniques in the treatment of extracranial carotid artery aneurysms. J Vasc Surg 2020; 73:2031-2035. [PMID: 33098945 DOI: 10.1016/j.jvs.2020.06.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Carotid artery aneurysms and pseudoaneurysms (extracranial carotid artery aneurysm [ECCAs]) are relatively rare. The gold standard treatment has historically been open repair; however, there is increasing evidence of successful treatment of ECCAs with endovascular techniques. Our study examines the evolving experience with endovascular management of ECCAs at a tertiary care center. METHODS We performed a retrospective analysis of patients with ECCAs who underwent endovascular interventions at a single institution from 2010 to 2020. With increasing experience, the techniques evolved from covered stents to stent-assisted coil embolization and finally to braided stents and overlapping closed cell stents. RESULTS There were 18 ECCAs in 17 patients treated with endovascular modalities. The average age was 65.9 years. There were 11 males (64.7%). Seven aneurysms (38.9%) were symptomatic: three patients had painless pulsatile masses, three patients had painful pulsatile masses, and one had transient ischemia attacks. Two (11.1%) were treated with covered stents, 2 (11.1%) were treated with stent-assisted embolization, 2 (11.1%) were treated with flow-diverting braided stents, 10 (55.6%) were treated with overlapping bare metal stents, and 2 (11.1%) were treated with embolization or ligation alone. Technical success was achieved in all patients. The mean duration of follow up was 338 days (range, 8-3039 days). No perioperative or postoperative complications were encountered, including no neurologic deficits and no embolic events. All patients were discharged on postoperative day 1 or 2. All 16 stents (100%) retained vessel patency on follow-up imaging and exclusion of ECCAs was confirmed on postprocedure surveillance imaging. CONCLUSIONS Endovascular modalities for the management of ECCAs have evolved with experience. Our study suggests that endovascular management is technically feasible as well as clinically effective and suggests an algorithm for navigating the various treatment modalities.
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Affiliation(s)
- James W Cornwall
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - C Y Maximilian Png
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Daniel K Han
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Rami O Tadros
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Michael L Marin
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Peter L Faries
- Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
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2
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Xue S, Tang X, Zhao G, Tang H, Shen Y, Yang EY, Fu W, Shi Z, Guo D. Contemporary Outcomes of Open and Endovascular Intervention for Extracranial Carotid Artery Aneurysms: A Single Centre Experience. Eur J Vasc Endovasc Surg 2020; 60:347-354. [PMID: 32631711 DOI: 10.1016/j.ejvs.2020.04.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/28/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the outcomes of open surgery (OS) and endovascular surgery (ES) for extracranial carotid aneurysm (ECCA) in the authors' centre. METHODS Fifty-seven consecutive patients who were diagnosed with ECCA and underwent intervention from January 2005 to July 2019 at Zhongshan Hospital, Fudan University, were reviewed retrospectively. Patient characteristics and surgical outcomes for OS and ES were analysed. ECCAs were divided into three morphological subgroups: subgroup Ⅰ, no severe tortuosity of the internal carotid artery (ICA) or common carotid artery (CCA) proximal to the aneurysm, tortuosity of the aneurysm and 1 cm of peri-aneurysmal carotid artery ≤ 90°; subgroup Ⅱ, severe ICA or CCA tortuosity proximal to the aneurysm, tortuosity of the aneurysm and 1 cm of peri-aneurysmal carotid artery ≤ 90°; subgroup Ⅲ, aneurysm tortuosity and 1 cm peri-aneurysmal carotid artery > 90°. RESULTS 35 patients underwent OS, 20 patients underwent ES and 2 patients underwent OS after the failure of ES. Thirty-six cases were classified in subgroup Ⅰ, 11 cases in subgroup Ⅱ, and 10 cases in subgroup Ⅲ. ES was achieved successfully in all 18 cases of subgroup I, but failed in three of four cases in subgroups Ⅱ and Ⅲ. With a mean duration of 62.9 ± 44.5 months of follow up, five deaths were recorded in the OS group, two of which were caused by ipsilateral stroke and three were not neurologically related. There was no stroke or death in the ES group during follow up. One case of stroke and two cases of death occurred in symptomatic patients, while one case of stroke and three cases of death occurred in asymptomatic patients. CONCLUSION This series demonstrates that ES may be a safe and durable option for ECCA in subgroup Ⅰ, while in subgroups Ⅱ and Ⅲ, ES alone may be difficult to apply. A 30 day stroke rate around 5% existed in ECCAs with interventions, which should be considered before the intervention.
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Affiliation(s)
- Song Xue
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao Tang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Gefei Zhao
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hanfei Tang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Shen
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ethan Y Yang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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3
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Cornwall JW, Png MCY, Tadros RO, Han DK, Marin ML, Faries PL. The Evolution of Endovascular Management of Extracranial Carotid Artery Aneurysms and Pseudoaneurysms. Vasc Endovascular Surg 2019. [DOI: 10.1177/1538574419871752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Extracranial carotid artery aneurysms and pseudoaneurysms (ECCAs) are rare pathologies with various etiologies, presentations, and management strategies. Historically, open aneurysm resection and arterial repair have been the gold standard management of ECCAs. Our study examines the evolving experience with endovascular management of ECCAs. Methods: We performed a literature review of multiple studies on endovascular and open management of carotid artery aneurysms and pseudoaneurysms. Conclusions: Endovascular stenting is technically feasible and clinically effective for the treatment of carotid artery aneurysms and pseudoaneurysms. Further follow-up is required regarding long-term safety and efficacy.
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Affiliation(s)
- James W. Cornwall
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Maximilian C. Y. Png
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Rami O. Tadros
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Daniel K. Han
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Michael L. Marin
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Peter L. Faries
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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4
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Endovascular Treatment with Two Overlapping Micromesh-Covered Stents and Balloon Guide Catheter for Symptomatic Carotid Pseudoaneurysm Ten Years after Eversion Endarterectomy. Ann Vasc Surg 2019; 58:379.e9-379.e13. [DOI: 10.1016/j.avsg.2018.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 11/23/2022]
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5
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Massara M, Notarstefano S, De Caridi G, Serra R, Prunella R, Impedovo G. Endovascular Treatment of a Carotid Pseudoaneurysm Using the New Double-Layer Micromesh Stent (Roadsaver ®). Ann Vasc Surg 2019; 59:308.e15-308.e18. [PMID: 31075470 DOI: 10.1016/j.avsg.2019.02.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/20/2022]
Abstract
Pseudoaneurysm (PA) formation after carotid endarterectomy (CEA) is a very uncommon but dangerous complication, potentially responsible for cerebral embolism or rupture. Therefore, the PA treatment is imperative. Until few years ago, the treatment of choice was represented by open surgical repair, with a higher mortality and morbidity rate than primary operation. Actually, the advancements in endovascular procedures allow the surgeon the possibility to recur to a less invasive approach in the presence of an adequate anatomy, reducing the risk of cranial nerve injuries. We present a case of post-CEA PA successfully treated using the double-layer micromesh stent (Roadsaver®; Terumo, Tokyo, Japan), with almost immediate thrombosis of the aneurysmal sac.
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Affiliation(s)
- Mafalda Massara
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Taranto, Italy
| | - Stefano Notarstefano
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Taranto, Italy
| | - Giovanni De Caridi
- Vascular Surgery Unit, Department of Biomedical Sciences, University of Messina, Messina, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy; Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
| | - Roberto Prunella
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Taranto, Italy
| | - Giovanni Impedovo
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Taranto, Italy
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6
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Yamamoto S, Akioka N, Kashiwazaki D, Koh M, Kuwayama N, Kuroda S. Surgical and Endovascular Treatments of Extracranial Carotid Artery Aneurysms—Report of Six Cases. J Stroke Cerebrovasc Dis 2017; 26:1481-1486. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 12/14/2022] Open
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7
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Santos Alcántara E, Ballesteros Pomar M, Pérez Pérez S, Novo Martínez G, Rodríguez López I. Compresión de la vía aérea superior secundaria a un pseudoaneurisma carotídeo. Semergen 2017; 43:e46-e48. [DOI: 10.1016/j.semerg.2016.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 10/20/2022]
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8
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Szopiński P, Iwanowski J, Kielar M, Noszczyk W. Posttraumatic Pseudoaneurysm of Stenotic Internal Carotid Artery Repair by Stent Graft. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857440003400118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report an intravascular treatment in the case of posttraumatic pseudoaneurysm of a stenotic internal carotid artery, using a stent graft.
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Affiliation(s)
- Piotr Szopiński
- I Chair and Clinic of Surgery of Warsaw Medical Academy, Warsaw, Poland
| | | | | | - Wojciech Noszczyk
- I Chair and Clinic of Surgery of Warsaw Medical Academy, Warsaw, Poland
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9
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Ilijevski NS, Gajin P, Neskovic V, Kolar J, Radak D. Postendarterectomy Common Carotid Artery Pseudoaneurysm. Vascular 2016; 14:177-80. [PMID: 16956493 DOI: 10.2310/6670.2006.00032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pseudoaneurysm (PSA) formation is an uncommon complication in carotid surgery. PSA of the carotid artery requires surgical or endovascular treatment to prevent PSA thrombosis, embolization from the thrombotic material within the PSA, hemorrhage after rupture, or compression on the adjacent structures. We present a case of a symptomatic common carotid PSA that occurred 14 months after routinely performed eversion carotid endarterectomy.
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Affiliation(s)
- Nenad S Ilijevski
- Vascular Surgery Clinic, Dedinje Cardiovascular Institute, Belgrade, Serbia and Montenegro.
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10
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Necial M, Sánchez Molero S, Araújo de Pazos M, de la Quintana Gordón M, Vázquez Rodríguez E, Pérez M. Masa cervical derecha secundaria a pseudoaneurisma de carótida común derecha. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Lopez D, Sarac T, Lorenz R. Primary Internal Carotid Artery Aneurysm in a 15-Year-Old Male: Case Report and Review of the Literature. Ann Vasc Surg 2015; 29:126.e1-4. [DOI: 10.1016/j.avsg.2014.07.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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12
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Successful Obliteration of a Pseudoaneurysm from Post-CEA Repair Secondary to a Pruitt-Inahara Shunt Using a Stent Graft. Case Rep Vasc Med 2013; 2013:382485. [PMID: 23984178 PMCID: PMC3747430 DOI: 10.1155/2013/382485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 07/13/2013] [Indexed: 11/22/2022] Open
Abstract
Pseudoaneurysms of the carotid artery are very uncommon complications following carotid endarterectomy. Pseudoaneurysms are usually caused by any kind of blunt injury or trauma during carotid artery surgery. CEA has become an increasingly more common vascular surgery performed in the United States. The standard of treatment for a carotid PA has been open surgical repair with excision of the defect and then a graft reconstruction of the artery. Advancements in endovascular intervention have helped to make it a more popular choice in treatment because of the positive results and less invasive approach. This case report describes the successful obliteration of a large post-CEA PA using a stent graft. The PA was likely secondary to the use of a Pruitt-lnahara Shunt because it was found to be distal to the endarterectomized area of the carotid artery which means that the defect was likely caused by the balloon portion of the shunt. This case demonstrates the feasibility of using endovascular interventional techniques to treat a PA using a stent graft.
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13
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Fukuhara S, Tyagi S, Bernik T. Bilateral giant extracranial carotid artery aneurysms. Ann Vasc Surg 2013; 27:354.e13-6. [PMID: 23340206 DOI: 10.1016/j.avsg.2012.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/21/2012] [Accepted: 08/14/2012] [Indexed: 11/19/2022]
Abstract
Extracranial carotid artery aneurysms (ECAAs) are rare and extremely challenging disease entities. Untreated ECAAs can lead to serious neurologic sequelae, primarily from thromboembolism. Because of the high incidence of major neurologic complications, surgical intervention is warranted in most cases. We report a 63-year-old woman with voice fatigue and difficulty swallowing. Upon work-up, we discovered bilateral giant ECAAs and treated them with a combination of aneurysmectomy, primary anastomosis, and an interposition polytetrafluoroethylene graft. Unique features of the aneurysms include their unprecedented size and bilaterality, which is exceedingly rare.
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Affiliation(s)
- Shinichi Fukuhara
- Division of Vascular Surgery, Department of Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY 10003, USA.
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14
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Carnini M, Piffaretti G, Lomazzi C. Stent–graft repair of carotid endarterectomy–related pseudoaneurysm. JOURNAL OF ACUTE DISEASE 2013. [DOI: 10.1016/s2221-6189(13)60098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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15
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Faure E, Canaud L, Marty-Ané C, Alric P. Endovascular repair of a left common carotid pseudoaneurysm associated with a jugular-carotid fistula after gunshot wound to the neck. Ann Vasc Surg 2012; 26:1129.e13-6. [PMID: 22981012 DOI: 10.1016/j.avsg.2012.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 03/31/2012] [Accepted: 04/11/2012] [Indexed: 12/31/2022]
Abstract
The management of traumatic injury of the common carotid artery has traditionally required a conventional surgical intervention, which is associated with a high mortality rate. Endovascular procedures might offer a less invasive alternative to treat these injuries, with a lower rate of mortality and morbidity. We report the case of a 30-year-old man who presented after penetrating injury due to a low-velocity gunshot wound to the neck. Angiography demonstrated a high-flow arteriovenous fistula and large false aneurysm of the common carotid artery. A self-expanding covered stent was placed across the injured portion of the artery, resulting in thrombosis of the aneurysm and preservation of the parent artery, without any significant complication. Covered stent placement is an alternative approach to treating carotid artery pseudoaneurysms associated with a jugular-carotid fistula.
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Affiliation(s)
- Elsa Faure
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
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16
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Moratti C, Andersson T. Giant extracranial aneurysm of the internal carotid artery in neurofibromatosis type 1. A case report and review of the literature. Interv Neuroradiol 2012; 18:341-7. [PMID: 22958775 DOI: 10.1177/159101991201800315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 04/15/2012] [Indexed: 01/30/2023] Open
Abstract
Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder characterized by cutaneous pigmentations, neurofibromas, Lisch nodules and neuroectodermal tumors. Supra-aortic vessel aneurysms may affect patients with NF-1 and can be associated with rupture, ischemic complications and compression symptoms. We describe a 48-year-old woman with NF-1 and an extracranial 3×5 cm right internal carotid artery aneurysm. After balloon test occlusion the patient was treated with parent artery sacrifice which led to significant shrinkage on follow-up MR and reduction of compression symptoms. The literature concerning internal carotid artery aneurysms associated with NF-1 is reviewed evaluating the possible therapeutic options.
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Affiliation(s)
- C Moratti
- Department of Neuroradiology, S. Agostino-Estense Hospital, Modena Local Health Trust, Modena, Italy
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17
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Extracranial internal carotid artery aneurysm: An uncommon disease of the supra-aortic arteries. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Hanakita S, Iijima A, Ishikawa O, Kamada K, Saito N. Treatment of a cervical carotid pseudoaneurysm that occurred years after laryngectomy and irradiation of a neck tumor. Neurol Med Chir (Tokyo) 2011; 51:588-91. [PMID: 21869583 DOI: 10.2176/nmc.51.588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 62-year-old man presented with rupture of a pseudoaneurysm of the left common carotid artery (CCA) that was induced after radiation therapy and neck surgery. The initial treatment was an endovascular procedure to obliterate the aneurysm with coils, and a covered stent was placed in the parent artery. However, the patient presented with subsequent coil migration, wound infection, and left CCA stenosis. Direct surgical procedures were then performed, including resection of the pseudoaneurysm with coils and stent; replacement of the carotid artery with a saphenous vein graft; and operative wound reinforcement with a pedicle flap. Endovascular treatments may be chosen for vascular diseases after irradiation, because of the low risk of wound infection and fragility of the vessels, but the long-term outcomes of intravascular treatments are still unclear. In direct surgery, dissection of the adhesive tissue and adequate wound healing are difficult. Musculocutaneous flaps with vascular pedicles can achieve good results.
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Affiliation(s)
- Shunya Hanakita
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
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19
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Alaraj A, Wallace A, Amin-Hanjani S, Charbel FT, Aletich V. Endovascular implantation of covered stents in the extracranial carotid and vertebral arteries: Case series and review of the literature. Surg Neurol Int 2011; 2:67. [PMID: 21697983 PMCID: PMC3115199 DOI: 10.4103/2152-7806.81725] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/26/2011] [Indexed: 12/14/2022] Open
Abstract
Background: Covered stents are used endovascularly to seal arterial wall defects while preserving vessel patency. This report describes our experience with the use of covered stents to treat cervical pathology, and a review of the literature in regards to this topic is presented. Case Description: Two patients presenting with the carotid blowout syndrome and one patient with a vertebrojugular fistula were treated with covered stents. This allowed for preservation of the vessel and was a treatment alternative to cerebral bypass. Conclusion: Covered stents provide a viable means of preserving the cervical vessels in selected patients; however, long-term follow-up is necessary to determine stent patency and permanency of hemostasis.
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Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, College of Medicine, Chicago IL, USA
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20
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[Extracranial internal carotid artery aneurysm: an uncommon disease of the supra-aortic arteries]. Neurologia 2011; 27:53-5. [PMID: 21481983 DOI: 10.1016/j.nrl.2011.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/24/2022] Open
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21
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Elpiniki T, Salviato E, Rocca T, Braccini L, Galeotti R, Mascoli F. Heparin Surface Stent-Graft for the Treatment of a Carotid Pseudoaneurysm. Ann Vasc Surg 2010; 24:952.e9-952.e12. [DOI: 10.1016/j.avsg.2010.02.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 02/21/2010] [Accepted: 02/22/2010] [Indexed: 11/25/2022]
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22
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Nishinari K, Wolosker N, Yazbek G, Bernardi CV, Zottele Bomfim GA. Covered stent treatment for an aneurysm of a saphenous vein graft to the common carotid artery. Ann Vasc Surg 2010; 24:954.e9-954.e12. [PMID: 20831999 DOI: 10.1016/j.avsg.2010.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 01/15/2010] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
Abstract
Aneurysmal degeneration of a saphenous vein graft is a rare complication and, so far, only three cases involving a carotid artery have been described. We report the case of a patient with a cervical neoplasm presenting carotid invasion, who underwent en bloc tumor resection and carotid reconstruction with a saphenous vein graft. Six years later, during follow-up, an aneurysm of the carotid graft was detected. Endovascular intervention was performed using a covered stent. Three years after this intervention, the patient was found to be asymptomatic, and computed tomography showed that the covered stent was patent, without complications.
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Affiliation(s)
- Kenji Nishinari
- Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo, Brazil.
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23
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Aneurisma verdadero de carótida interna extracraneal. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Ellens DJ, Hurley MC, Surdel D, Shaibani A, Pelzer H, Bendok BR. Radiotherapy-induced common carotid pseudoaneurysm presenting with initially occult upper airway hemorrhage and successfully treated by endovascular stent graft. Am J Otolaryngol 2010; 31:195-8. [PMID: 20015736 DOI: 10.1016/j.amjoto.2008.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 12/11/2008] [Accepted: 12/31/2008] [Indexed: 12/19/2022]
Abstract
Radiation induced carotid vasculopathy may present as steno-occlusive disease or less commonly as a pseudoaneurysm. The latter most often presents with a pulsatile mass but is a potential cause of life threatening hemorrhage. We present a case of a small common carotid artery (CCA) pseudoaneurysm that was initially dismissed as the cause of the patients presenting epistaxis given its small size and location. After standard bilateral internal maxillary artery embolizations failed to prevent significant subsequent pharyngeal and tracheal blood loss and serial imaging demonstrated a progressive enlargement of the pseudoaneurysm, a stent graft was successfully placed across the lesion. At five months post stenting, follow-up imaging of the neck showed a stable obliteration of the pseudoaneurysm, good arterial patency, and the patient remained free of recurrent hemorrhage. This case demonstrates that even a small carotid pseudoaneurysm, can present with pharyngeal hemorrhage and should be treated aggressively--with endovascular stent grafting being a preferred treatment modality for arterial lesions in the irradiated neck.
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Affiliation(s)
- Damien J Ellens
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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Reslan OM, Ebaugh JL, Raffetto JD. Bilateral asymptomatic extracranial carotid artery aneurysms. Ann Vasc Surg 2010; 24:691.e11-6. [PMID: 20409683 DOI: 10.1016/j.avsg.2010.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 09/18/2009] [Accepted: 02/08/2010] [Indexed: 11/29/2022]
Abstract
Aneurysms of the extracranial carotid arteries are rare and account for 0.4-1% of all arterial aneurysms and about 4% of all peripheral arterial aneurysms. Causes include atherosclerosis, fibromuscular dysplasia, trauma (penetrating and blunt cervical trauma and hyperextension of the neck), iatrogenic lesions, infection, congenital defects, and irradiation arteritis. Atherosclerosis is responsible for 46-70% of all carotid artery aneurysms. The most frequent site of carotid artery aneurysms is the common carotid artery, particularly at its bifurcation and proximal internal carotid artery (ICA). The middle and distal portions of the ICA are the next most common sites. Aneurysms at the point of bifurcation are usually fusiform, whereas those located in the middle and distal portions of the ICA are usually saccular. This uncommon but interesting vascular disorder usually presents as a parapharyngeal pulsatile mass. It can be partially or completely thrombosed and thereby cause embolization or compression of neurovascular structures, with ruptures and ischemic events as other complications. Surgical treatment of extracranial carotid aneurysms is required in most cases, to avert disastrous consequences. Conservative management of extracranial ICA aneurysms has resulted in a mortality rate of nearly 71%. Nonoperative treatment is generally indicated in young patients who have nonpenetrating traumatic and spontaneously dissecting aneurysms. However, when anticoagulation therapy fails or when persistent neurologic symptoms or progressive expansion of the aneurysm occurs, surgical repair is indicated.
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Affiliation(s)
- Ossama M Reslan
- Department of Surgery, American University of Beirut, Beirut, Lebanon
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Malikov S, Thomassin JM, Magnan PE, Keshelava G, Bartoli M, Branchereau A. Open surgical reconstruction of the internal carotid artery aneurysm at the base of the skull. J Vasc Surg 2010; 51:323-9. [DOI: 10.1016/j.jvs.2009.08.084] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 08/21/2009] [Accepted: 08/22/2009] [Indexed: 11/25/2022]
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Srivastava SD, Eagleton MJ, O'Hara P, Kashyap VS, Sarac T, Clair D. Surgical Repair of Carotid Artery Aneurysms: A 10-Year, Single-Center Experience. Ann Vasc Surg 2010; 24:100-5. [DOI: 10.1016/j.avsg.2009.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 08/12/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Abdelhamid MF, Wall ML, Vohra RK. Carotid Artery Pseudoaneurysm After Carotid Endarterectomy: Case Series and a Review of the Literature. Vasc Endovascular Surg 2009; 43:571-7. [DOI: 10.1177/1538574409334827] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare complication with incidence less than 1%. There is a potential for rupture, embolization, thrombosis or compression of cranial nerves. Objective: We reviewed our experience and compare it to the literature to raise awareness of this rare though serious condition. It is crucial to treat these patients early to avoid the hazardous consequences. Methods: A review of the case records of patients who had CEA at University Hospital Birmingham (UHB) NHS Foundation Trust from 1990-2007, was undertaken. Information of patients including their aetiology, presenting features, treatment and results was collected. The English-language literature was searched using PubMed database for post CEA pseudoaneurysm. Results: Five patients developed post CEA PA. This represents 0.4% of the 1200 CEA performed at our hospital in the last 18 years. The timing of their presentation varied from three days to eight months after the original operation. All had patch reconstruction after CEA. Patches were intact at exploration of the PAs. There was one death and one stroke. The literature revealed 154 carotid PAs after CEA and two cases following carotid stenting 52 of these cases had infected PA. Patients with synthetic patches have the least incidence of infection. More than 80% had open surgery and 9% had endovascular repair. Conclusion: Post CEA surveillance is necessary to detect patients with PA early. Factors that favour infection must be avoided. Endovascular repair of carotid PA should be encouraged in specialised centres.
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Affiliation(s)
- Mohamed F. Abdelhamid
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, United Kingdom,
| | - Michael L. Wall
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, United Kingdom
| | - Rajiv K. Vohra
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, United Kingdom
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Choudhary AS, Evans RJ, Naik DK, Tripathi RK, Wickremesekera JK. Surgical management of extracranial carotid artery aneurysms. ANZ J Surg 2009; 79:281-7. [DOI: 10.1111/j.1445-2197.2009.04860.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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30
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Attigah N, Külkens S, Zausig N, Hansmann J, Ringleb P, Hakimi M, Eckstein HH, Allenberg JR, Böckler D. Surgical Therapy of Extracranial Carotid Artery Aneurysms: Long-Term Results over a 24-Year Period. Eur J Vasc Endovasc Surg 2009; 37:127-33. [DOI: 10.1016/j.ejvs.2008.10.020] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 10/18/2008] [Indexed: 11/17/2022]
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Yi AC, Palmer E, Luh GY, Jacobson JP, Smith DC. Endovascular treatment of carotid and vertebral pseudoaneurysms with covered stents. AJNR Am J Neuroradiol 2008; 29:983-7. [PMID: 18296552 DOI: 10.3174/ajnr.a0946] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular treatment of vascular lesions has revolutionized the treatment of arterial pseudoaneurysms. We describe our experience in treating carotid or vertebral pseudoaneurysms with covered stents. MATERIALS AND METHODS Ten patients with carotid or vertebral pseudoaneurysms treated with self-expanding or balloon-expandable covered stents were retrospectively reviewed after we obtained institutional review board approval. Distal protection devices were not used. All patients except 1 received anticoagulation therapy. Antiplatelet therapy was used in 8 of 10 patients. Follow-up was performed from 5 days to 25 months. Patients were followed with digital subtraction angiography, CT angiography (CTA), and/or sonography (US). RESULTS Pseudoaneurysm occlusion was obtained in all 10 patients. None of the pseudoaneurysms recanalized during the follow-up period. One patient had a distal embolization to the middle cerebral artery despite anticoagulation and antiplatelet therapy. One patient who did not receive any anticoagulation had stent occlusion at 4.5 months. Anticoagulation was stopped after 6 months in 2 patients with persistent stent patency and no neurologic complications for >1 year. Both US and CTA were useful for extracranial stent surveillance. CTA was helpful for intracranial stent surveillance. CONCLUSION In this small series, the use of covered stents allowed safe and effective treatment of pseudoaneurysms occurring in the cervical and cephalic segments of the carotid and vertebral arteries.
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Affiliation(s)
- A C Yi
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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32
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Cerebrovascular Disease. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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33
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Szabó GV, Szeberin Z, Bíró G, Laczkó A, Dzsinich C, Acsády G. [Bilateral internal carotid aneurysms]. Magy Seb 2007; 60:262-6. [PMID: 17984018 DOI: 10.1556/maseb.60.2007.5.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors discuss the treatment of five patients with bilateral carotid aneurysms and review the relevant literature. During the preoperative workup duplex scan, angiography and CT scan were obtained. The diameter of the aneurysms was in the range from 9 to 40 mm. Treatment plans were largely individualized. Two patients had bilateral and two had unilateral reconstructions carried out with end-to-end anastomosis. One patient was treated conservatively. In one case, a staged approach was chosen due to multiple aneurysms. As a postoperative complication, a reversible stroke was detected in one patient. All patients were followed up (between 3 to 14 years) by six monthly duplex scans. The authors suggest surgical treatment for carotid aneurysms with a diameter above 15 mm, increasing size, thrombotic plaques or neurological sings in order to avoid high risk complications (compression, rupture, embolisation).
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Affiliation(s)
- Gábor Viktor Szabó
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Er- és Szívsebészeti Klinika, 1122 Budapest, Városmajor utca 68.
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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 2007; 29:958-68. [PMID: 16897263 DOI: 10.1007/s00270-005-0367-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures. METHOD We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case. RESULTS We identified 20 patients with traumatic extracranial ICA pseudoaneurysms due to penetrating craniocervical injuries or skull base fractures who had been treated with covered stent-graft implantation. Many discrepancies have been ascertained regarding the anticoagulation therapy. In 3 patients the ICA was totally occluded in the follow-up period, giving an overall occlusion rate 15%. No serious complication was reported as a result of the endovascular procedure. CONCLUSION Preliminary results suggest that placement of stent-grafts is a safe and effective method of treating ICA traumatic pseudoaneurysms resulting from penetrating craniocervical injuries or skull base fractures. The immediate results are satisfactory when the procedure takes place with appropriate anticoagulation therapy. The periprocedural morbidity and mortality and the early patency are also acceptable. A surveillance program with appropriate interventions to manage restenosis may improve the long-term patency.
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MESH Headings
- Adult
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Anticoagulants/therapeutic use
- Blood Vessel Prosthesis Implantation
- Carotid Artery Injuries/diagnostic imaging
- Carotid Artery Injuries/etiology
- Carotid Artery Injuries/surgery
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/surgery
- Coated Materials, Biocompatible/therapeutic use
- Combined Modality Therapy
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/etiology
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/diagnostic imaging
- Head Injuries, Penetrating/surgery
- Humans
- Male
- Polytetrafluoroethylene/therapeutic use
- Radiography
- Skull Fracture, Basilar/complications
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/surgery
- Stents
- Vascular Patency
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Affiliation(s)
- Dimitrios Maras
- Department of Vascular Surgery, The Red Cross Hospital of Athens, Athens, Greece
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35
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Ahuja V, Tefera G. Successful Covered Stent-Graft Exclusion of Carotid Artery Pseudo-aneurysm: Two Case Reports and Review of Literature. Ann Vasc Surg 2007; 21:367-72. [PMID: 17484973 DOI: 10.1016/j.avsg.2006.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 06/05/2006] [Accepted: 06/09/2006] [Indexed: 11/18/2022]
Abstract
Postendarterectomy carotid artery pseudo-aneurysm (CPA) is a relatively infrequent complication with an estimated incidence of 0.3%-0.6%. A report from a single center experience on open-surgical repair of CPA has shown the associated high morbidity and mortality. Endovascular therapy is emerging as a safer alternative to open-surgical therapy. We describe two cases of CPA treated with commercially available Viabahn stent graft system (Gore AL, Flagstaff, AZ).
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MESH Headings
- Aged
- Aged, 80 and over
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Blood Vessel Prosthesis Implantation
- Carotid Artery Diseases/surgery
- Carotid Artery, Common/diagnostic imaging
- Carotid Artery, Common/pathology
- Carotid Artery, Common/surgery
- Endarterectomy, Carotid/adverse effects
- Female
- Humans
- Male
- Reoperation
- Stents
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Duplex
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Affiliation(s)
- Vanita Ahuja
- University of Wisconsin Medical School, Madison, WI 53792, USA
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36
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Lipari G, Riva F, Muselli P, Armatura G, Lino M, Shamale A, Baggio E. Anévrismes de l’artère carotide interne extra-crânienne : à propos de 2 cas. ACTA ACUST UNITED AC 2006; 31:152-8. [PMID: 16840953 DOI: 10.1016/s0398-0499(06)76535-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Aneurysms of the extracranial portion of the internal carotid artery (ICA) are rare (accounting for only 0.1-2% of all surgical procedures affecting the ICA, 0.4-1% of all arterial aneurysms, and 4% of all aneurysms involving peripheral arteries), but they are nonetheless clinically significant because of the high related risk of cerebral thromboembolism. Given the rarity of these lesions, it seems worthwhile to report on two extracranial ICA aneurysms, one of atherosclerotic, the other of fibrodysplastic etiology that came under our observation. PATIENTS AND METHODS Our experience concerns just two cases, treated at the Department of Surgical and Gastroenterological Sciences of the Policlinico G.B. Rossi in Verona, presenting with very different clinical and instrumental findings, and requiring a different surgical treatment. The former underwent resection of the aneurysm and end-to-end reconstruction; in the latter, we performed a carotid transposition with internalization of the external carotid artery. RESULTS Neither patient suffered from any major or minor neurological complications during or after surgery, and the follow-up confirmed a normal extracranial carotid patency. CONCLUSIONS Based on our, albeit limited experience and an analysis of the literature, we make a few points concerning the diagnostic approach (which differs from the case of stenosing carotid lesions), the indications and type of treatment for extracranial ICA aneurysms.
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Affiliation(s)
- G Lipari
- Département de Sciences Chirurgicales et Gastro-entérologiques de l'Université de Vérone.
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Bakoyiannis CN, Georgopoulos SE, Tsekouras NS, Klonaris CN, Skrapari IC, Papalambros EL, Bastounis EA. SURGICAL MANAGEMENT OF EXTRACRANIAL INTERNAL CAROTID ANEURYSMS BY CERVICAL APPROACH. ANZ J Surg 2006; 76:612-7. [PMID: 16813628 DOI: 10.1111/j.1445-2197.2006.03787.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extracranial internal carotid artery aneurysms (EICAA) are rare vascular problems with a great potential for lethal thromboembolic episodes. METHODS From 1994 to 2004, nine patients with EICAA, seven men and two women, were surgically treated for 10 aneurysms in our department. Aneurysm led to hemispheric symptoms in six cases (two hemispheric strokes and four hemispheric transient ischaemic attacks). The cause was fibrodysplasia in two cases, atherosclerosis in four cases, trauma in two cases and spontaneous dissection in two cases. All aneurysms were treated surgically by the cervical approach using shunting. Extended cervical approach was necessary in four patients with high-lying aneurysms. Nine aneurysms were totally resected and successful revascularization was carried out. Open aneurysmorrhaphy with vein patch angioplasty was carried out in one case of a saccular aneurysm. RESULTS There were no perioperative deaths or transient ischaemic attacks or strokes. Four patients developed cranial nerve deficits: one had hoarsness, two had partial facial paralysis (patients with extended cervical approach) and one had tongue deviation. These neurological symptoms were observed in large aneurysms (>4.5 cm) and disappeared within 14 months. No neurological complication was observed in a follow up that ranged from 6 months to 10 years. CONCLUSIONS Surgical repair of EICAA, especially with total resection and arterial reconstruction, is strongly recommended. Extended cervical approach has many technical difficulties but can allow treatment of high-lying aneurysms.
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Affiliation(s)
- Chris N Bakoyiannis
- First Department of Surgery, University of Athens Medical School, Laiko Hospital, Athens, Greece.
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38
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Oliveira AFD, Kajita D, Garzon RGDA, Centola CAP, Bosnardo CAF, Francischelli Neto M. Tratamento endovascular de pseudo-aneurisma de carótida interna em criança. J Vasc Bras 2006. [DOI: 10.1590/s1677-54492006000100013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Relato de um caso de paciente feminina, com 6 anos de idade, que apresentou uma massa cervical, dolorosa e com características de processo infeccioso, que revelou ser um pseudo-aneurisma de carótida interna. Foi realizado o tratamento endovascular, com o uso de um balão destacável que determinou a oclusão e conseqüente trombose do pseudo-aneurisma, com excelente resultado.
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Abstract
Carotid artery aneurysms are an uncommon but important problem. The available data suggests that, untreated, these aneurysms lead to neurologic symptoms from embolization. Pseudoaneurysms of the carotid artery result from injury or may be the long-term sequelae of a spontaneous carotid dissection. While open surgery has been the primary mode of treatment, these aneurysms are being treated more commonly with endovascular approaches. This trend is partly the result of the increasing experience with the endovascular treatment of carotid artery stenosis. The endovascular approach offers advantages in other situations where open access to the distal extent of the aneurysm is difficult or neck radiation leads to concerns about wound healing. This article outlines the etiology, new diagnostic modalities, and treatment of aneurysms of the carotid artery.
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Affiliation(s)
- G Matthew Longo
- Division of Vascular Surgery, Northwestern University, Chicago, IL 60611, USA
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40
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de Vries JPPM, Meijer RW, van den Berg JC, Meijer JMR, van de Pavoordt EDWM. Stent Fracture After Endoluminal Repair of a Carotid Artery Pseudoaneurysm. J Endovasc Ther 2005; 12:612-5. [PMID: 16212463 DOI: 10.1583/05-1597.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To present a case in which a covered stent fractured 7 months after implantation in the internal carotid artery (ICA). CASE REPORT A 59-year-old man presented with a large traumatic pseudoaneurysm of the left ICA. Seven months after successful treatment with a covered Symbiot stent, clinical complaints recurred because the pseudoaneurysm recanalized due to fracture of the stent at its midsection. Surgical stent explantation was needed, with polytetrafluoroethylene graft reconstruction of the ICA. No complications occurred in the periprocedural period. A control duplex scan 12 months later showed exclusion of the pseudoaneurysm and no graft-related complications. CONCLUSIONS This case demonstrates an as yet unreported complication of stent-grafting in a carotid artery.
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41
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Akiyama Y, Nakahara I, Tanaka M, Iwamuro Y, Hayashi J, Harada K, Fujimoto M. Urgent Endovascular Stent-Graft Placement for a Ruptured Traumatic Pseudoaneurysm of the Extracranial Carotid Artery. ACTA ACUST UNITED AC 2005; 58:624-7. [PMID: 15761362 DOI: 10.1097/01.ta.0000096662.79685.ea] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yasuhiko Akiyama
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
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McCready RA, Divelbiss JL, Bryant MA, Denardo AJ, Scott JA. Endoluminal repair of carotid artery pseudoaneurysms: A word of caution. J Vasc Surg 2004; 40:1020-3. [PMID: 15557919 DOI: 10.1016/j.jvs.2004.07.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report describes our results with covered endoluminal stents in the management of 4 patients with carotid artery pseudoaneurysms (PSAs) following carotid endarterectomy (CEA). Two patients had symptomatic embolization of thrombus from the PSA's into branches of the middle cerebral arteries (MCA) during deployment of the stents. Endoluminal stents were deployed uneventfully in the other two. At 12 month follow-up, one patient had an occlusion of the stent. While endoluminal therapy of carotid PSAs in an effective method to exclude PSAs, embolization of thrombus is a potential hazard. The long-term patency of covered stents in the carotid artery is unknown.
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Affiliation(s)
- Robert A McCready
- Department of Vascular Surgery, Clarian Health Partners, Inc, Methodist Hospital, USA.
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43
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Gupta PC, Madhavilatha N, Venkateshwarlu J, Sudha A. Extracranial carotid aneurysm related to pregnancy. J Vasc Surg 2004; 40:375-8. [PMID: 15297837 DOI: 10.1016/j.jvs.2004.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Carotid aneurysms are rare, and pregnancy-related carotid aneurysms are rarer still. We report the case of an extracranial carotid aneurysm related to pregnancy. It was noted in the 20th week of gestation, and was uncomplicated. Surgery was successfully performed urgently to preempt embolism or rupture. The patient had a full-term normal delivery. The graft is patent, and the patient has no symptoms at 28-month follow-up. To the best of our knowledge, this case represents the first successful repair of an extracranial carotid aneurysm during pregnancy.
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Affiliation(s)
- P C Gupta
- Department of Vascular & Endovascular Surgery, Medwin Hospital & Heart Institute, Hyderabad, India.
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44
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Aneurisma de carótida extracraneal con estenosis crítica contralateral. ANGIOLOGIA 2004. [DOI: 10.1016/s0003-3170(04)74848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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45
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Hertz JA, Minion DJ, Quick RC, Moore EM, Schwartz TH, Endean ED. Endovascular Exclusion of a Postendarterectomy Carotid Pseudoaneurysm. Ann Vasc Surg 2003; 17:558-61. [PMID: 14738085 DOI: 10.1007/s10016-003-0034-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Carotid pseudoaneurysms are rare occurrences. They often result from trauma, but can also present following carotid endarterectomy. Treating such pseudoaneurysms can be difficult due to previous surgery and limited access to the high internal carotid artery. A case involving a postendarterectomy carotid pseudoaneurysm treated via a femoral approach with a covered stent using endoluminal techniques is presented.
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Affiliation(s)
- Jeffrey A Hertz
- Division of Vascular Surgery, University of Kentucky School of Medicine, Lexington 40536, USA
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46
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Terramani TT, Workman MJ, Loberman Z, Dawson DL, Bush RL, Lumsden AB, Lin PH. Adjunctive endovascular techniques in the management of postoperative carotid artery pseudoaneurysms--useful armamentarium for vascular surgeons--three case reports. Vasc Endovascular Surg 2003; 37:207-12. [PMID: 12799730 DOI: 10.1177/153857440303700308] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postoperative carotid artery pseudoaneurysms are rare. The traditional treatment of choice has been operative repair, which can present a significant technical challenge owing to the reoperative neck inflammation and potential cranial nerve injuries. The authors report 3 cases of postoperative carotid pseudoaneurysms that were successfully managed by use of various adjunctive endovascular techniques. The adjunctive endovascular maneuvers included the following: 1) endoluminal balloon placement for preoperative test occlusion and intraoperative proximal control to facilitate operative dissection in the first patient with a carotid pseudoaneurysm; 2) endoluminal stent-graft placement to exclude a large expanding carotid pseudoaneurysm in the second patient; and 3) endoluminal coil placement along with balloon occlusion to achieve complete hemostasis in the third patient, who presented with a hemorrhaging carotid pseudoaneurysm. Successful outcomes were achieved in all 3 patients by use of adjunctive endovascular techniques. These cases underscore the role of adjunctive endovascular treatment as an armamentarium for vascular surgeons in the treatment of complex carotid pseudoaneurysms.
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Affiliation(s)
- Thomas T Terramani
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Forbes T, Nie R, Kirk Lawlor D. Saccular Aneurysm of the Extracranial Internal Carotid Artery. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1533-3167(03)00049-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Vascular and trauma surgeons have seen a marked increase in the incidence of traumatic injury of the ECCA. Making the diagnosis is straightforward, but requires a high index of suspicion. This patient's injury is from hyperextension/flexion trauma that occurred from repetitive rides on roller coasters.
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Affiliation(s)
- Kurt R Stahlfeld
- Department of General Surgery, Mercy Hospital of Pittsburgh, Pittsburgh, PA 15219, USA.
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Bemelman M, Donker DN, Ackerstaff RG, Moll FL. Bilateral extracranial aneurysm of the internal carotid artery--a case report. VASCULAR SURGERY 2001; 35:225-8. [PMID: 11452350 DOI: 10.1177/153857440103500311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report a case study of a 78-year-old man with a bilateral extracranial atherosclerotic aneurysm of the internal carotid artery. The patient was treated surgically with resection of the aneurysm and restoration of the flow with a polytetrafluoroethylene (PTFE) graft. The postoperative period was uneventful. Histologic tests demonstrated almost complete destruction of the elastin fibers. The potential hazards of an aneurysm of the internal carotid artery indicate that surgical treatment is warranted.
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Affiliation(s)
- M Bemelman
- Department of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands.
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Bush RL, Lin PH, Dodson TF, Dion JE, Lumsden AB. Endoluminal stent placement and coil embolization for the management of carotid artery pseudoaneurysms. J Endovasc Ther 2001; 8:53-61. [PMID: 11220470 DOI: 10.1177/152660280100800109] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To present a series of carotid artery pseudoaneurysms treated successfully using an endovascular approach. METHODS From April 1995 to November 1999, 5 patients with neurological symptoms not explained by computed tomography of the head were identified by carotid angiography as having internal carotid artery (ICA) pseudoaneurysms. Three patients had sustained blunt trauma, and 2 had previous elective carotid endarterectomies for atherosclerotic disease. The time between injury and treatment ranged from 3 days to 10 years. The patients were treated with endovascular stent placement for exclusion of the pseudoaneurysm, followed by filling of the cavity with multiple detachable coils. Patients were maintained on oral antiplatelet agents or anticoagulant therapy after the procedure. RESULTS Primary technical success was 100%. No patient suffered permanent neurological sequelae. Postprocedure angiography demonstrated a patent ICA in all cases, with complete obliteration of the pseudoaneurysm. At a mean 8.4-month follow-up (range 2-21), all patients remained symptom free; angiograms in 3 patients at a mean 11.7 months demonstrated continued ICA patency. One patient had a 60% focal narrowing of the distal common carotid artery, which was treated successfully with balloon dilation and stenting. CONCLUSIONS Endovascular treatment of carotid artery pseudoaneurysms is a useful alternative to standard surgical repair. This modality avoids the necessity for surgical exposure at the skull base with its inherent morbidity.
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Affiliation(s)
- R L Bush
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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