Extracranial Internal Carotid Artery Pseudoaneurysm Research Articles

Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review

The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases. The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration. Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P= 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P= 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P= 0.001). In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.

Posttraumatic pseudoaneurysm of the internal carotid artery extracranial segment due to chronic intimal transection - case report

Introduction. Carotid artery pseudoaneurysms can refer to pseudoaneurysms involving any segment of the carotid arteries. Post?traumatic internal carotid artery pseudoaneurysm dilatation due to intimal transection is extremely rare entity that requires detailed clinical examination and multiple diagnostic modalities to confirm the diagnosis. The aim of the study is to present rare entity of posttraumatic extracranial internal carotid artery pseudoaneurysm dilatation due to intimal transection, diagnostic algorithm and diagnostic findings. Case Report. The patient was a 30-year-old, previously healthy, female who came to see a cardiologist due to intermittent tachycardia, which first appeared a week before the examination. Duplex ultrasound was performed, and aneurysm of extracranial segment of internal carotid artery was found. The patient had severe neck trauma due to bicycle accident in childhood, which was treated at home, without medical examination. Further computed tomography angiography and magnetic resonance angiography were performed. All imaging findings were in favor of chronic arterial wall small pseudoaneurysmal dilatation, with intimal transection, without signs of acute trauma. Based on the above, a decision was made to continue conservative treatment in accordance with the recommendations of current guidelines. Periodic clinical diagnostic follow-up was performed. After the applied therapy, the complaints in terms of intermittent tachycardia disappeared completely. Conclusion. Formation of extracranial internal carotid artery pseudoaneurysm due to intimal transection is a rare entity, and requires multiple imaging findings in order to evaluate if the trauma is acute or chronic. In most cases, chronic pseudoaneurysm does not require surgical intervention. It requires conservative medical treatment and diagnostic follow-up.

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

Akinduro, Oluwaseun O MD; Gopal, Neethu MD; Hasan, Tasneem F MD, MPH, CPH; Nourollah-Zadeh, Emad MD; Vakharia, Kunal MD; De Leacy, Reade MD; Burkhardt, Jan-Karl MD; Yamamoto, Junichi MD; Mocco, J MD; Castilla, Leonardo Rangel MD; Kan, Peter Tze Man MD; Boulos, Alan MD; Levy, Elad MD; Tawk, Rabih G MD

Flow diversion device for the management of an extracranial internal carotid artery aneurysm.

Our patient is a 60-year-old woman with a history of hypertension, hypothyroidism, and glossal hemangioma. She works as a standardized patient actor in our simulation center. A neck ultrasound scan performed during one of the simulation sessions demonstrated a left internal carotid artery aneurysm, which prompted a consultation with Vascular Surgery. She denied any symptoms associated with this aneurysm. On physical examination, there was a palpable pulsatile mass below the left mandibular angle. On computed tomography angiography, a 2.3- × 1.9- × 2.2-cm saccular aneurysm of the extracranial left internal carotid artery was noted (A). After multidisciplinary discussion, the decision was made to proceed with endovascular treatment using flow diversion due to the patient's desire of avoiding a scar in the neck, aneurysm size, and risk for thrombus formation and embolization. A 5.0- × 25-mm Pipeline flow-diversion device (PED; Medtronic) was deployed across the lesion with no event. The patient was observed overnight and discharged the following day with a normal neurological examination and on aspirin 81 mg and clopidogrel 75 mg daily as an antiplatelet regimen. On 1-month follow-up computed tomography angiography, the stent demonstrated excellent apposition to the wall of the artery and excellent flow through this vessel (B). Extracranial carotid artery aneurysm has a prevalence of 0.4%-1% among all peripheral artery aneurysms.1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar The neurologic symptoms experienced by patients include transient ischemic attacks and ischemic strokes.2Welleweerd J.C. den Ruijter H.M. Nelissen B.G. Bots M.L. Kappelle L.J. Rinkel G.J. et al.Management of extracranial carotid artery aneurysm.Eur J Vasc Endovasc Surg. 2015; 50: 141-147Google Scholar The first successful treatment for an aneurysm in this location was performed by Sir Astley Cooper in 1808 through ligation of the proximal carotid artery.3Kraemer C.J.K. Zhou W. Carotid aneurysm review.Int J Angiol. 2019; 28: 17-19Google Scholar Then, in 1952, Dimtza4Dimtza A. Aneurysms of the carotid arteries; report of two cases.Angiology. 1956; 7: 218-227Google Scholar reported the first successful resection with end-to-end anastomosis. In the past 10 years, with the development of endovascular techniques, the treatment options of carotid artery aneurysms have included open surgery, endovascular procedures, and hybrid techniques.1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar A review published by Qiu et al1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar reports that the optimal management option for the treatment of carotid artery aneurysms is dependent on the morphology of the artery and the properties of the aneurysm. Recent advances in endovascular treatment allow for the utilization of flow diversion outside the skull, and treatment of extracranial internal carotid artery pseudoaneurysms with flow diversion has been shown to be safe and effective in selected patients.5Akinduro O.O. Gopal N. Hasan T.F. Nourollah-Zadeh E. Vakharia K. De Leacy R. et al.Pipeline embolization device for treatment of extracranial internal carotid artery pseudoaneurysms: a multicenter evaluation of safety and efficacy.Neurosurgery. 2020; 87: 770-778Google Scholar Informed consent was obtained from this patient for this publication.

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.

Extracranial Internal Carotid Artery Pseudoaneurysm Associated With Neurofibromatosis Type 1 Treated With Endovascular Stenting and Coil Embolization

An internal carotid artery (ICA) pseudoaneurysm associated with neurofibromatosis type 1 (NF-1) is rare. We report the first case of unruptured extracranial pseudoaneurysm of the ICA in a patient with NF-1 successfully treated with endovascular stenting and coil embolization.A 66-year-old woman diagnosed with NF-1 had sudden left neck pain and massive swelling 3 years earlier. Radiological examination showed a ruptured pseudoaneurysm of the left internal thoracic artery (ITA). The posttreatment computed tomography (CT) scan revealed complete obliteration of the aneurysm of the left ITA and an unruptured pseudoaneurysm of the right ICA. After 3 years of follow-up, a CT scan revealed the enlargement of the pseudoaneurysm of the right extracranial ICA. Endovascular stenting and coil embolization were performed to prevent rupture, and the lesion was completely obliterated. Follow-up angiography at 6 months revealed good flow of the ICA through the stent without any filling of the aneurysm.

Thrombin Injection Failure with Subsequent Successful Stent-Graft Placement for the Treatment of an Extracranial Internal Carotid Pseudoaneurysm in a 5-Year-Old Child

Internal carotid artery pseudoaneurysm is a rare life-threatening condition that may develop in different clinical situations. We report the case of an extracranial internal carotid artery pseudoaneurysm secondary to a throat infection in a pediatric patient that was initially treated with percutaneous thrombin injection under ultrasound guidance. However, recanalization occurred at 48h, and definitive treatment was then performed by endovascular stent-graft placement. We briefly review the clinical characteristics of this uncommon clinical condition as well as the treatment options.

小児頭蓋外内頚動脈仮性動脈瘤の1例

小児頭蓋外内頚動脈仮性動脈瘤の1例

Extracranial Internal Carotid Artery Pseudoaneurysms after Kinking Reconstruction

The purpose of this report is to describe our experience of infected false aneurysm treatment following internal carotid artery (ICA) reconstruction. Five and 6 years before admission, bilateral reconstruction was done because of ICA kinking at a local health center. The patient was symptomless for 5 years but later became partially symptomatic (dizziness, vertigo, and visibly bilateral neck pulsatile masses). On routinely performed ultrasonography and multislice scanner examinations, the bilateral ICA pseudoaneurysms were revealed. The final treatment was surgery and aneurysmal sac resection followed by end-to-end arterial reconstruction. A right-sided wound swab was positive; Staphylococcus aureus was cultured. Antibiotics were administered: teicoplanin (Targocid) 800 mg as an initial dose followed by 400 mg maintenance doses over the following 4 days. After 1 month, left ICA reconstruction was done and a wound swab showed staphylococcal infection as well. At the 12-month follow-up, the patient was doing well; cerebral vascularization was well preserved. Infected false aneurysms are rare complications following carotid artery reconstruction. Aneurysmal sac resection and arterial reconstruction with end-to-end anastomosis or autologous saphenous vein are recommended. A wound swab is mandatory.

Usual and unusual causes of splaying of the carotid artery bifurcation: the lyre sign—a pictorial review

The 'Lyre' sign describes the characteristic splaying of the carotid artery bifurcation due to a carotid body tumour (paraganglioma) on conventional carotid angiography. In this pictorial review, we describe and illustrate two cases demonstrating the equivalent Lyre sign on multi-detector computed tomography (MDCT) and ultrasound resulting from carotid body tumour and extra-cranial internal carotid artery pseudoaneurysm. Both of these pathologies can manifest acutely and warrant accurate diagnosis to prevent potential catastrophic consequences. We also emphasise the added value of MDCT in making a definitive diagnosis and discuss other differential considerations splaying the carotid bifurcation.

Pseudoaneurysm of Internal Carotid Artery

Pseudoaneurysms of the extracranial Internal Carotid Artery (ICA) are rare. Here it is reported a case of posttraumatic extracranial ICA pseudoaneurysm in a three-year-old boy. The pseudoaneurysm arising from the extracranial ICA was initially diagnosed by DSA. Later on confirmed by Doppler and MRA. The imaging features are described with a brief review of literature.

Covered Stent-Graft Treatment of Traumatic Internal Carotid Artery Pseudoaneurysms: A Review

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. We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case. 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. 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.

Embolization of an Extracranial Internal Carotid Artery Pseudoaneurysm

Deep neck space infections are rarely complicated by pseudoaneurysms of the extracranial internal carotid artery. This condition has a high mortality rate with conservative management and significant morbidity with open surgical techniques. Recent advances in endovascular therapy have allowed embolization of the diseased vessel to be performed with a more acceptable safety profile. We report a case of an extracranial internal carotid artery pseudoaneurysm complicating a deep neck space infection in an adolescent that was treated with selective endovascular embolization. We present the findings of computed tomography, magnetic resonance angiography, and conventional angiography.

Internal Carotid Artery Aneurysm With Life-Threatening Hemorrhages in a Pediatric Patient:Endovascular Treatment Options

To describe the management of a pediatric patient with recurrent, life-threatening nasopharyngeal hemorrhages due to a pseudoaneurysm of the internal carotid artery (ICA), most likely caused by deep neck infection following peritonsillar abscess. An 11-year-old boy presented with lymphadenopathy of the neck, torticollis, and difficulty swallowing that had persisted for some weeks. After sneezing, the patient suffered massive recurrent nasopharyngeal hemorrhages leading to anemia. Computed tomography identified a 2 x 2-cm hematoma in the left parapharyngeal space; angiography revealed a saccular aneurysm (14.1 x 8.2 mm) of the extracranial ICA adjacent to the skull base, without ongoing hemorrhage. A bare Wallstent was initially implanted, but total exclusion was achieved only after secondary placement of a Symbiot covered stent within the bare stent. This case demonstrates the utility of an endovascular approach to an extracranial ICA pseudoaneurysm in a pediatric patient.

Internal Carotid Artery Pseudoaneurysm Related to Pregnancy

Arterial rupture is a common cause of maternal death. The increased tendency of true and false aneurysms to develop or rupture with advancing gestational age suggests that hemodynamic, hormonal, or other physiologic changes of pregnancy may play a role in their formation. To our knowledge, pseudoaneurysm formation from a carotid dissection or a ruptured true aneurysm related to pregnancy has not been previously reported. We report the successful repair of a large extracranial internal carotid artery pseudoaneurysm related to pregnancy. The clinical presentation, diagnostic modalities, surgical exposure, and treatment options for high internal carotid artery aneurysms will be discussed.