Carotid Artery Pseudoaneurysm Research Articles

超急性期に血管内治療を行った巨大総頸動脈仮性動脈瘤破裂の1例(Urgent endovascular treatment of a huge ruptured common carotid artery pseudoaneurysm: a case report)

要旨 総頸動脈仮性動脈瘤（common carotid artery pseudoaneurysm: CCAPa）破裂は，巨大血腫を形成し，気道閉塞となる。我々は，気道緊急に陥ったCCAPa破裂例に対して，初期治療後，血管内治療を行ったので報告する。症例は65歳の男性。突然頸部が腫脹し，気道狭窄のため当院搬送となった。SpO2 60%（BVM換気，酸素10L/min），ショックを呈していた。頸部正中は偏位し，喉頭鏡で声門は視認できなかった。超音波ガイド下で気管切開を行い，急速輸液で循環を維持した。安定化処置後の3DCTAでは，左CCAに3.5cm大の巨大仮性動脈瘤と血腫を認めた。血管撮影では，CCAPaからextravasationを認めたため，左CCAで遮断テストを行い，側副血行路を確認後，コイルによるCCA閉塞を行った。第4病日，頸動脈エコーで，CCAの血流再開を認め，再塞栓術を行い，以後再開通はなかった。第7病日，呼吸器から離脱，離床が可能となった。超急性期に，血管内治療でCCAを閉塞し，脳循環維持も可能であった。脳循環維持につながる迅速な安定化治療と低侵襲の血管内治療の組み合わせは，超急性期治療の1つとなりうる。

Ruptured infectious ICA pseudoaneurysm into the sphenoid sinus after maxillofacial infection, successfully treated by selective embolization

Background: Intracranial infectious aneurysms are cerebral aneurysms caused by pathogen-induced inflammation undermining the arterial wall. We present a rare case of inflammatory pseudoaneurysm of cavernous internal carotid artery (ICA).Case Description: A 51-year-old female with a recent diagnosis of acute lymphoblastic leukemia developed maxillofacial infection with Pseudomonas and Acinetobacter after chemotherapy onset. Initial plain computed tomography (CT) revealed bony dehiscence of the left ICA canal, as well as bilateral protrusion of the vessel within the sphenoid sinus. Following infection spread into the left sphenoid sinus, she presented with episodes of intermittent epistaxis, without any profound vascular abnormalities on postcontrast CT. CT angiography that was performed 15 days later, due to refractory epistaxis, illustrated a large narrow necked irregular shape pseudoaneurysm of the left paraophthalmic ICA, extending into the ipsilateral sphenoid sinus. The aneurysm was completely occluded by selective embolization without parent or adjacent vessel sacrifice, documented on both intraoperative and follow-up angiogram, with no recurrence of epistaxis.Conclusion: Conclusively, ruptured internal carotid infectious aneurysms are rare but potentially fatal causes of epistaxis when extended into the sphenoid sinus. Selective coiling is feasible and can provide definitive treatment of these lesions.

Treatment strategies for patients with concurrent blunt cerebrovascular and traumatic brain injury

Patients who present with traumatic brain injury (TBI) combined with blunt cerebrovascular injuries (BCVI) are difficult to manage, in part because treatment for each entity may exacerbate the other. It is necessary to develop a treatment paradigm that ensures maximum benefit while mitigating the opposing risks. A cohort of 150 patients from 2015 to present, with either internal carotid artery (ICA) and/or vertebral artery (VA) dissections or pseudoaneurysms, was cross-referenced with those who had sustained TBI. Of the 38 patients identified with both TBI and BCVI, 25 suffered ICA injuries, 10 had VA injuries and 3 had combined ICA/VA injuries. Unilateral BCVI occurred in 30 patients, while 8 had bilateral BCVI. Two patients required surgical intervention for TBI, and 5 patients required endovascular intervention for BCVI. Positive emboli detection studies (EDS) on transcranial dopplers (TCD) were demonstrated in 19 patients, with 9 patients having radiographic evidence of stroke. Anti-platelet therapy was initiated in 32 patients, and anti-coagulation in 10 patients, without new or worsening intracranial hemorrhages (ICH). Overall, 76% of patients were able to be discharged home or to rehabilitation, with good recovery demonstrated in 73% of the patients who had appropriate follow-up. In the setting of concurrent TBI and BCVI, use of anti-platelet/coagulation to prevent stroke can be safe if monitored closely. Here we describe a treatment paradigm which weighs the risk and benefits of therapies based on severity of ICH and stroke prevention, which tended to result in good disposition and recovery.

Endovascular Double-Layer Bare Stent Placement in the Treatment of Posttraumatic Pseudoaneurysm.

Objective To investigate the efficacy and safety of endovascular double-layer bare stent placement for the treatment of traumatic false aneurysm (TFA). Methods This is a retrospective review of five patients with TFA undergone double-layer bare stent placement in our center between February 2011 and August 2020. There are 2 males and 3 females aged 29-65 years, with an average age of 43 years. One case suffered from common carotid artery pseudoaneurysm, and four cases suffered superficial femoral artery pseudoaneurysm. Results The endovascular interventional treatment was successful in all 5 patients, and the pseudoaneurysms disappeared after treatment. No TFA recurrence and no complications such as instent stenosis, stent migration, stent fracture, endoleak, and infection were observed during the 3-99-month follow-up period. Conclusion For the treatment of TFA, endovascular interventional therapy with double-layer bare stent was minimally invasive, safe, and effective with fewer complications. It could preserve all branches of parent artery and had the advantage of lower cost. It can be used in the treatment of TFA in selected cases. However, further clinical researches with larger cohorts are needed before its long-term efficacy can be completely clarified.

Intractable Epistaxis Secondary to Traumatic Pseudoaneurysm of Internal Carotid Artery

Intractable Epistaxis Secondary to Traumatic Pseudoaneurysm of Internal Carotid Artery

Treatment of large infectious extracranial carotid artery pseudoaneurysms in children: a systematic review of the literature.

Extracranial carotid artery pseudoaneurysm is a rare complication of deep neck space infection, and no evidence-based treatment guidelines are available in the literature. To clarify the existing experience of the different treatment strategies, the authors performed a systematic literature search using the PubMed, Ovid EMBASE, and Scopus databases in accordance with PRISMA guidelines to review all reported cases of pediatric patients with infectious carotid pseudoaneurysms larger than 1 cm. Twenty-six patients with a median age of 4 years (range 6 months-15 years) were identified. Eighteen patients (69.2%) were treated with endovascular methods, 6 patients (23.1%) with surgical methods, 1 patient (3.8%) with a hybrid endovascular/surgical approach, and 1 patient (3.8%) with conservative management. Recurrence of the pseudoaneurysm occurred in 2 cases (7.7%), both of which were successfully retreated. Of the 6 patients (23.1%) who presented with pre-procedure neurologic deficits, 3 patients had complete or near complete resolution of symptoms after intervention and 3 patients had persistent deficits at last follow-up. Four patients (15.4%) experienced new neurologic deficits post-procedure that resolved at last follow-up. The endovascular treatment tends to be the preferred option to treat a large or giant infectious pseudoaneurysm of the carotid artery in the pediatric patient. However, more evidence is necessary to elucidate comparative safety and efficacy profiles of endovascular and surgical management strategies.

Acute onset of massive epistaxis due to post-traumatic cavernous internal carotid artery pseudoaneurysm

Rationale: Cavernous internal carotid artery (ICA) pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis. The sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical practice. The management is often challenging because of anatomical inaccessibility of the bleeding point. Patient's concern: A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive epistaxis. Diagnosis: A computerized tomography (CT) scan showed a fracture in the sphenoid sinus. CT angiogram revealed cavernous ICA pseudoaneurysm. Interventions: Endovascular coil embolization. Outcomes: The patient recovered well and was discharged without any neurological deficits Lessons: Cavernous ICA pseudoaneurysm may lead to a life-threatening situation. If a patient has a history of head trauma, post-traumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.

A case wherein transoral carotid ultrasonography was performed before and after stent-assisted coil embolization for a pseudoaneurysm of the cervical internal carotid artery

A case wherein transoral carotid ultrasonography was performed before and after stent-assisted coil embolization for a pseudoaneurysm of the cervical internal carotid artery

Endovascular management of internal carotid artery pseudoaneurysms: Retrospective observational study

Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) are caused by multiple etiological factors and can involve any segment. There are no clear guidelines to select treatment options in managing these cases. A retrospective review of all patients treated for ICA PSAs by endovascular treatment was conducted. Details of clinical presentations, imaging modalities, angiographic findings and endovascular treatment were noted. Four male (57%) and three female (43%) patients were treated. Their ages ranged from ten months to 52 years old. Five patients had cervical ICA PSAs, and one patient each had PSA of petrous and paraclinoid ICA segment. Five patients had traumatic etiology, one patient had post-infective mycotic and one patient had iatrogenic PSA. The most common presentation was pulsatile neck swelling (n = 5). Two patients (n = 2) presented with massive bleeding, one patient had stroke with aphasia and transient limb weakness, while the patient with petrous PSA had tinnitus and ear pain. Parent artery occlusion (PAO) was performed in six patients (n = 6). In three patients (n = 3), we used stent grafts to trap the ICA. Two patients (n = 2) underwent PAO with coils. In one patient, we used liquid embolic agent (Histoacryl) for PAO. An aneugraft pericardium covered stent was used in one patient. All patients experienced good angiographic results, without any neurological complication. There was no re-canalization of the aneurysm on follow ups. Endovascular approach is a feasible treatment option, with multiple alternative occlusion techniques and a low complication rate. PAO still remains a simple, safe, effective treatment in selective patients.

Pseudoaneurysm of the Internal Carotid Artery After Craniofacial Traumatism: Series of Cases and Integrative Literature Review.

The present study aims to develop an integrative review about pseudoaneurysms after traumatic facial trauma, through the analysis of its etiology, type of fracture, signs and symptoms, time elapsed between the trauma and the exposure of signs and symptoms, and treatment performed in these cases. Furthermore into the report, there are 3 clinical cases that occurred in the Buccomaxillofacial Surgery and Traumatology service of Hospital da Restauração Recife/PE. The study was carried out in 2 phases, first, a digital research about post-traumatic craniofacial pseudoaneurysm was performed in the following databases "MEDLINE/PubMed," "Scielo" and "Scopus," in September 2019, with 5 articles being included. In the second, 3 cases of patients with high-impact facial trauma who developed pseudoaneurysm of the internal carotid artery were reported. The average age of the patients was 35.6 years, all patients were male (100%), the majority (60%) being victims of an automobile accident, 3 patients (60%) suffered craniofacial trauma and 2 (40%) had trauma only to the face, most of them had symptoms later on due to the trauma, in 80% of cases the therapy instituted was embolization. Cases of high-impact craniofacial traumas, which present epistaxis and/or ophthalmological alterations correlated to fractures, should be carefully evaluated, determining a better prognosis for the patient.

Traumatic cavernous internal carotid artery pseudoaneurysm presenting with massive epistaxis-a morbid clinical entity

<p>Epistaxis is commonly encountered by clinicians in emergency department. However, severe and recurrent epistaxis is very uncommon especially that arise from the cavernous internal carotid artery (ICA) pseudoaneurysm. Traumatic cavernous internal carotid pseudoaneurysm is a rare cause of the epistaxis but is a fatal and life-threatening clinical condition if left untreated. Massive epistaxis following head injury should alert the clinician to rule out traumatic cavernous ICA pseudoaneurysm. Traumatic pseudoaneurysm of the cavernous part of the ICA is a challenging clinical entity both in diagnosis and treatment. This clinical diagnosis may be suspected in case of patient with history of head injury, massive recurrent epistaxis and delayed onset of blindness. Massive epistaxis after head trauma should alert the clinician for possible cavernous ICA pseudoaneurysm. Carotid angiography confirms the site of pseudoaneurysm. The treatment options are endovascular stent and coil embolization, arterial balloon occlusion and surgical trapping. Timely diagnosis and treatment of this condition give a favorable outcome. In this review article, we discuss the epidemiology, etiopathology, clinical presentations, investigations and current treatment of the traumatic cavernous ICA pseudoaneurysm.</p>

A Case of Pseudoaneurysm of the Common Carotid Artery Presented with Upper Airway Obstruction

Extracranial carotid artery aneurysms account for only 1% of all arterial aneurysms and therefore they are quite rare pathology. Patients with those aneurysms present with a pulsatile neck mass, neurological events such as a stroke and a cranial nerves dysfunction due to compression effects. Because of the high risk of a rupture and thromboembolic events, it is recommended to repair these aneurysms either utilizing open surgical or endovascular approach. This report details a case of a female patient with a common carotid artery pseudoaneurysm presented with upper airway obstruction. Tracheotomy was performed as a lifesaving procedure. We opted for an endovascular management because of the existing tracheostomy that could complicate surgical approach. Pseudoaneurysm was successfully managed with an endovascular deployment of self-expanding stent graft.

Imaging and Intervention in Internal Carotid Artery Pseudoaneurysm Secondary to Retropharyngeal Abscess.

Vascular complications secondary to retropharyngeal abscess are rarely encountered in the post antibiotic era and include compression of internal carotid artery (ICA), infective arteritis and pseudoaneurysm formation. Post infectious ICA pseudoaneurysm formation is reported predominantly in the paediatric age group and rare in adults. We report a case of retropharyngeal abscess complicated by ICA pseudoaneurysm in an adult successfully managed by endovascular approach.

Pipeline Embolization Device for Treatment of Extracranial Internal Carotid Artery Pseudoaneurysms: A Multicenter Evaluation of Safety and Efficacy.

There is a paucity of literature regarding treatment options for extracranial pseudoaneurysms of the internal carotid artery (ICA). To date, Pipeline Embolization Device (PED; Medtronic Inc) use for the treatment of extracranial pseudoaneurysms of the ICA has only been reported from single-center case series. To evaluate the safety and efficacy of PED for the treatment of extracranial ICA pseudoaneurysms. This is a multicenter retrospective study involving 6 high-volume tertiary academic institutions in the United States. We analyzed patients with extracranial ICA pseudoaneurysms treated with PED between January 1, 2011, and January 1, 2019. Clinical assessment was performed pre- and postintervention using the modified Rankin Scale (mRS) and National Institution of Health Stroke Scale (NIHSS) at a minimum of 4-mo follow-up. A total of 28 pseudoaneurysms with a mean diameter of 17.7 mm (range: 4.1-52.5 mm) were treated with PED in 24 patients at 6 participating centers. The mean age was 52.1 yr (17-73) ± 14.3 with 14 females and 10 males. At a mean of 21-mo (range 4-66 mo) follow-up, complete occlusion was achieved in 89% (n=25/28), with near-complete occlusion (>90% occlusion) in the remainder. There were no periprocedural complications. Postprocedure NIHSS was 0 in 88% (n=21/24) and 1 in 12% (n=3/24) of patients, and mRS was 0 in 83% (n=20/24) and 1 in 17% (n=4/24) of patients. The treatment of extracranial ICA pseudoaneurysms with PED is safe and effective in selected patients. Randomized controlled trials and prospective cohort studies are needed to establish the role of flow diversion for ICA pseudoaneurysms.

The Exchange-Free Technique: A Novel Technique for Enhancing Surpass Flow Diverter Placement.

Background:Following flow diverter placement, approximately 20% of intracranial aneurysms remain as residual aneurysms at 1 year. Device malapposition is a cause of residual aneurysms after flow diversion. We present a new and straightforward technique (exchange-free technique [EFT]) to enhance apposition of the surpass flow diverter (SFD), the only over-the-wire flow diverter currently available.Materials and Methods:We deployed laser-cut mini stents through the inner deployment catheter of the SFD. This maneuver was performed simply by withdrawing the micro-guidewire from its lumen and replacing it with a mini-stent (stents deliverable through microcatheters with inner diameter of 0.0165 inches), without a need to re-cross the deployed SFD or an exchange maneuver. All aneurysms in which this technique was utilized were retrospectively reviewed.Results:Twenty-eight patients (20 females) with 30 treated aneurysms were identified. The mean aneurysm diameter was 10.2 ± 6.6 mm. Technical success rate was 96.6% (29/30 aneurysms). There was no mortality or permanent morbidity related to the procedures. Except for the patient treated for an iatrogenic, surgery-related internal carotid artery pseudoaneurysm who died secondary to consequences of multiple surgeries, no cases of mortality or permanent morbidity were noted. Complete aneurysm occlusion rates were 78.2%, 82.1%, and 95.2% at 0–3, 3–6, and 9–12 months, respectively. None of the patients were re-treated.Conclusion:EFT is a simple and fast technique which was not associated with adverse effects in our series. The higher aneurysm obliteration rate obtained with EFT is probably the result of better wall apposition of the SFD.

POCUS and POCDUS: essential tools for the evaluation and management of carotid artery pseudoaneurysms after a gunshot wound

BackgroundEvaluation of asymptomatic penetrating vascular injuries can be done with Point-of-care ultrasound (POCUS) and Point-of-care Doppler ultrasound (POCDUS).Case presentationA 21-year-old woman was admitted to the Emergency Department with a small wound and pain on the left side of her neck. The patient stated she was standing outside her home and suddenly felt acute pain in the neck. She denied trauma or being assaulted and reported no significant past medical or surgical history. On physical exam the only positive finding was a small gunshot entry wound on the left side of her neck without hard signs of vascular injury. Bedside POCUS demonstrated soft tissue swelling and a hematoma next to the left carotid artery. A round in shape bullet was visualized in contact with the posterior left common carotid artery wall and two small saccular pseudoaneurysms were seen at left common carotid artery wall. POCDUS showed a patent left carotid artery and turbulent flow in the two saccular aneurysms. A computed tomography angiogram (CTA) was performed confirming the findings and a stent in left carotid artery was placed. The patient tolerated the procedure well and was discharged 4 days after the procedure. At the sixth month follow-up, Doppler ultrasound showed patent stent and resolution of the muscular hematoma.ConclusionsPenetrating trauma-related vascular injuries are complex cases to handle within an acute setting. POCUS and POCDUS are increasingly being used for the workup and decision-making process of gunshot-related vascular injuries to the neck and are a fundamental part of the follow-up after definitive therapy.

Catastrophic complication of a hemodialysis catheter: A giant carotid artery pseudoaneurysm.

Indwelling a hemodialysis catheter is a common practice in early care of end-stage renal disease patients. Most indwell cases were non-traumatic and non-complicated, but as in our presented case, improper placement of hemodialysis catheter can cause serious complications like pseudoaneurysm, stroke, or airway collapse. We presented a giant extracranial carotid artery pseudoaneurysm after an improper placement and removal of a temporary hemodialysis catheter.

Case of Mycotic Pseudoaneurysm of the Common Carotid Artery due to Salmonella typhi Bacteremia

Aneurysm of the extracranial carotid artery is a rare disease, mycotic pseudoaneurysms being even less common. They are a life-threatening complication of systemic infection and atherosclerosis. Immunocompromised people, including patients with HIV, uncontrolled diabetes melltus, those on immunosuppressants like high-dose steroids, and chemotherapy, are at a higher risk for development of mycotic pseudoaneurysms. Due to the high risk of potential complications like rupture and thromboembolic events, mycotic aneurysms always require surgical management. Early detection followed by restoration of blood flow is critical to minimize a fatal outcome. Here we report the case of a 52-year-old man with a past history of hypertension and dyslipidemia who presented with a pulsatile painful neck swelling. On evaluation, the patient was diagnosed to have Salmonella typhi bacteremia, HIV infection, and a mycotic aneurysm of the left common carotid artery.

Transcarotid repair of carotid artery pseudoaneurysm after carotid artery endarterectomy with tandem distal internal carotid artery stenosis.

Pseudoaneurysm development after carotid endarterectomy is a rare occurrence. Even rarer is pseudoaneurysm formation associated with a distal carotid artery stenosis. We report the case of stent grafting of a carotid artery pseudoaneurysm and tandem high-grade distal stenosis through a transcarotid approach with active flow reversal. No reported cases of a transcarotid artery approach to address a carotid artery aneurysm with tandem stenosis were found in the literature. We show that it may be a safe alternative to a transfemoral artery approach or open surgery.

External auditory canal haemorrhage as the first sign of internal carotid artery pseudoaneurysm: a rare case: a case report

Assessing the cause, severity of bleeding and strategies to control bleeding is crucial. We describe a rare case of a patient who was presented with epistaxis and left ear haemorrhage, as a probable complication of a ruptured internal carotid artery pseudoaneurysm. The massive haemorrhage compelled blood transfusion and clinical intervention. The diagnosis of internal carotid artery (ICA) pseudoaneurysm measuring 2.9 cm x 3.7 cm was concluded by computed tomography. Several coils were used to embolize the internal carotid artery pseudoaneurysm and arrest the bleeding with the guidance of an angiography. Coiling the pseudoaneurysm is highly recommended. Yet, the best methods to completely treat aneurysm are still in question. After the clinical intervention, the patient remained symptom-free and no episodes of bleeding were noted.