IP107. Endovascular Repair of Spontaneous Common Carotid Pseudoaneurysm With Covered Stent: A Case Report

Abstract

Covered stents are primarily used for treatment of arterial aneurysms, pseudoaneurysms and traumatic arterial injuries especially in high-risk patients. However, their use in carotid pseudoaneurysms remains uncommon and is limited to case reports and small case series. We report a successful case of endovascular treatment of a spontaneous right common carotid artery pseudoaneurysm with a covered stent. Our patient is 45-year-old woman with no comorbidities, who presented with complaints of pulsatile swelling of right side of neck, insidious in onset and gradually progressing in size over last 2 months. History of right upper limb acute limb ischemia category III of the right upper limb for which she underwent right above-elbow amputation 25 days earlier in another hospital. No history of trauma or signs of cranial nerve palsy were present. Computed tomography angiogram revealed a 7 × 7-cm contained hematoma with 2 × 2-cm pseudoaneurysm of the common carotid artery with a 7-mm neck, arising 11 mm from the common carotid artery origin (Fig 1). The patient was not willing to undergo open surgical repair, so she underwent right common carotid and distal innominate covered stenting with FLUENCY 9 × 60-mm via right femoral approach (Fig 2). In this particular case distal innominate is covered so as to achieve a 2-cm sealing zone and because she had already underwent right above-elbow amputation with a healed stump, there is no threat of acute ischemia after covering the subclavian ostia. The operative and perioperative periods were uneventful. Thrill and bruit disappeared in the immediate postoperative period. Postoperative duplex examination showed no endoleak with good flow across stent graft. This study highlights that carotid pseudoaneurysm can be managed safely and effectively with covered stent graft.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)