Stent-grafting for the Large Common Carotid Artery Aneurysm

Abstract

Spontaneous large aneurysms of the common carotid artery (CCA) are rare. Treatment strategy has not yet been established. We treated a patient with a spontaneous large aneurysm of the CCA with a stent-graft. We hereby report the case of successful endovascular treatment and its angiographic and ultrasonographic outcome. Case A 64-year-old woman with a history of transient right-sided hemiparesis visited our outpatient clinic at November 20, 2003. In addition, she had suffered from the soft mass getting larger in the neck. Carotid ultrasonography showed a large aneurysm of the right CCA in her neck, and the large aneurysm was her palpable soft mass. Magnetic resonance angiography (MRA) and carotid arteriography displayed it clearly. However, no vascular lesions were found referable to transient right-sided hemiparesis. She had no history of serious neck or head traumas After showing some treatment options, she hoped to undergo endovascular treatment with a stent-graft at January 20, 2004. Pre-operative angiography showed the large right CCA aneurysm with 19 x11 x 6 mm in size and the diameter of the right CCA near the aneurysm was about 7 mm. Under local anesthesia, we introduced 10Fr long sheath type guiding catheter into the right femoral artery and navigated it proximal to the right CCA aneurysm. After systemic anticoagulation with heparin, we measured carefully the diameter of the aneurysm by IVUS (intra-vascular ultrasonography). Then, we navigated a microcatheter (RapidTransit, Cordis) inside the right CCA aneurysm through the left femoral artery for possible coil embolization. We successfully deployed a self-expandable stent-graft (PASSAGER 10 mm _ 40 mm, Boston Scientific) through the 10-Fr guiding sheath and dilated it sufficiently with an 8mm balloon catheter. Immediately after post dilatation, the stent-graft was expanded enough to contact the CCA wall, and the aneurysm disappeared on angiograms. Therefore, we didn't perform coil embolization. Post-procedure carotid arteriography showed no visualization of the aneurysm. Three-month and twelve-month carotid ultrasonography and arteriography demonstrated complete obliteration and no recurrence of the right CCA aneurysm.