Endovascular Treatment of Shunt-Induced Carotid Pseudoaneurysm: Less Invasive but Still a Big Risk

Abstract

Objective: Carotid artery pseudoaneurysm (PSA) is a challenging complication of carotid endarterectomy (CEA). We present a case and literature review of post-CEA PSAs successfully treated percutaneously with a covered stent. Methods: A 57-year-old woman underwent a CEA of the left internal carotid artery using patch closure and selective shunting using a Pruitt-Inahara shunt. She was found to have a 3-cm incidental carotid artery PSA 3 months later distal to the endarterectomized portion of the artery, the injury likely resulting from the clamp or the balloon portion of the shunt. A percutaneous 5-mm 25-mm Viabhan (Gore, Flagstaff, Ariz) covered stent was deployed to successfully exclude the PSA. The patient suffered no complications. Follow-up duplex imaging at 3 and 6 months and at 1 year confirmed PSA sealing and patency of the internal carotid artery. Results: A PubMed search of the topic found 15 patients (Table) with post-CEA PSA treated with a covered stent. The results revealed the procedure is technically feasible with acceptable patency rates, the longest being 9 years. The procedure, however, caries a significant rate of periprocedural complications: one (7%) bleeding complication, four strokes (26%) and two deaths (13%). Conclusions: Endovascular repair of carotid PSA with a covered stent can be successfully performed; however, high complication rates should be considered before undertaking the procedure. Review of literature on results of endovascular treatment of postoperative carotid artery pseudoaneurysm using covered stents