Internal Carotid Artery Pseudoaneurysm Research Articles

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.

Evaluation and embolization strategy by ASITN/SIR grade for injured internal carotid artery of nasopharyngeal carcinoma

Objective: To study the strategy of endovascular treatment for patients with the risks of internal carotid artery (ICA) rupture and bleeding during the treatment of nasopharyngeal carcinoma (NPC) based on American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grade of collateral circulation. Methods: A total of 56 patients (45 males and 11 females, aged from 28 to 76 years old) diagnosed with nasopharyngeal carcinoma and admitted to the Department of Neurosurgery, the Third Affiliated Hospital of Southern Medical University from July 2018 to January 2020 were retrospectively analyzed. There were 15 cases of ASITN/SIR grade 4, 24 cases of ASITN/SIR grade 3, 5 cases of ASITN/SIR grade 2, 5 cases of ASITN/SIR grade 1, and 7 cases of ASITN/SIR grade 0. The events of stroke and death were analyzed statistically. Results: ALL patients with ASITN/SIR grade 4 or 3 and some of patients with ASITN/SIR grades 2-0 passed balloon occlusion test and electrophysiological monitoring. ICA pseudoaneurysm was found in 35 patients, and one-stage ICA embolization was performed in 29 patients after evaluation. Among them, 8 cases of ASITN/SIR grade 4 and 10 cases of ASITN/SIR grade 3 with obvious posterior circulation compensation obtained successful one-stage ICA embolization without cerebral ischemia; cerebral ischemic events occurred in 5 (55.6%) of 9 patients with ASITN/SIR grade 3 and in 1(50.0%) of 2 patients with ASITN/SIR grade 2. The total incidence of ischemic events was 20.7% (6/29) and 1 case was disabled (1/29, 3.4%). Among patients with ASITN/SIR 3, there were statistically significant differences in stroke event rate between patients with obvious posterior circulation compensation and patients with slight or without posterior circulation compensation (0/10 vs. 5/9, χ(2)=4.95, P=0.026). Follow-up time was 10.1±7.8 months, and 46 patients were survival (46/56, 82.1%) and 10 patients died (10/56, 17.9%) with a mean survival time of 2.6±1.4 months. Conclusions: For NPC patients with ICA invasion, ASITN/SIR based on DSA can simplify the assessment process of cerebral blood flow compensation. ICA can be embolized directly in patients with ASITN/SIR 4 or 3 with obvious posterior communicating compensation.

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.

Posttraumatic cavernous internal carotid artery pseudoaneurysm causing massive epistaxis: Our experiences at a tertiary care teaching hospital of eastern India

Background: Pseudoaneurysm of the cavernous internal carotid artery (ICA) is an uncommon clinical incidence. This may cause massive epistaxis and pose a life-threatening situation for patient. Aim: The aim of this study to acquaint the clinicians with this rare cause of the massive epistaxis due to posttraumatic pseudoaneurysm of the cavernous ICA. This study evaluates the details of patient's profile including presenting symptoms, investigation, treatment, and outcomes. Materials and Methods: Data of seven patients with cavernous ICA pseudoaneurysm presenting with epistaxis from March 2018 to April 2020 were retrospectively reviewed. Results: The age range of the patients was from 22 to 64 years. Duration of head trauma to the epistaxis ranged from 1 month to 4 months. All had history of head trauma. All were managed by endovascular coil embolization. Conclusion: Cavernous ICA pseudoaneurysm can cause life-threatening epistaxis. Patients present with severe epistaxis and history of head trauma should be thought for traumatic pseudoaneurysm of cavernous ICA. Endovascular coil embolization of the pseudoaneurysm is an important option for effective treatment.

A Case of Traumatic Internal Carotid Artery Pseudoaneurysm Diagnosed by Massive Bleeding During Endoscopic Sinus Surgery

A Case of Traumatic Internal Carotid Artery Pseudoaneurysm Diagnosed by Massive Bleeding During Endoscopic Sinus Surgery

Rupture of an Internal Carotid Artery Pseudoaneurysm and Bleeding of the Sphenopalatine Artery in a Patient with Skull Base Osteoradionecrosis after Radiotherapy for Sphenoid Sinus Carcinoma

Rupture of an Internal Carotid Artery Pseudoaneurysm and Bleeding of the Sphenopalatine Artery in a Patient with Skull Base Osteoradionecrosis after Radiotherapy for Sphenoid Sinus Carcinoma

Pseudoaneurysm of Internal Carotid Artery following Endoscopic Endonasal Pituitary Surgery requiring Endovascular Treatment in an Acromegalic Patient with a Difficult Airway

AbstractA pituitary tumor scheduled for surgical excision can eventuate with a myriad of challenges. A 49-year-old acromegalic patient was admitted to our hospital for trans-nasal trans-sphenoidal pituitary surgery. Magnetic resonance imaging (MRI) of his brain revealed a well-defined lesion involving right half of the anterior lobe of pituitary. In the operating room, we encountered difficulty in management of the airway. The trachea could be intubated using fiberoptic bronchoscope via a proseal laryngeal mask airway after five attempts of failed intubation. Intraoperatively, the right internal carotid artery (ICA) was injured during excision of lateral part of the tumor with a blood loss of 3.5 L. Adenosine use to aid hemostasis was unsuccessful. Endovascular coil embolization was done to treat the pseudoaneurysm developed in the right ICA, to restore the blood flow. During this process, the patient developed medial rectus palsy and ptosis in the right eye, which improved gradually. The above amalgamation of maladies commanded an integrated and well-coordinated team approach to manage the catastrophic complications.

Endovascular Treatment of a Giant Extracranial Carotid Artery Pseudoaneurysm in a Child Using Vascular Plugs

Carotid artery pseudoaneurysm is a rare but serious complication of a retropharyngeal abscess in children. We report the first case of treating an unruptured mycotic pseudoaneurysm of the extracranial internal carotid artery (ICA) in a pediatric patient with vascular plugs. A 3-year-old patient presented with airway compromise and signs of neck sepsis. Successful embolization of the pseudoaneurysm was achieved with 2 Amplatzer vascular plugs to close the front and back door. The patient did not have any neurological deficit. Repeat imaging with ultrasound and computed tomography confirmed no recurrence of the pseudoaneurysm.

In Reply to the Letter to the Editor Regarding “Endovascular Treatment of Infectious Pseudoaneurysm of Internal Carotid Artery”

In Reply to the Letter to the Editor Regarding “Endovascular Treatment of Infectious Pseudoaneurysm of Internal Carotid Artery”

Letter to Editor Regarding “Endovascular Treatment of Infectious Pseudoaneurysm of Internal Carotid Artery”

Letter to Editor Regarding “Endovascular Treatment of Infectious Pseudoaneurysm of Internal Carotid Artery”

Large Traumatic Skull Base Internal Carotid Artery Pseudoaneurysm managed With Endovascular Flow Diversion: 2-Dimensional Operative Video.

We present a case of a traumatic skull base internal carotid artery (ICA) pseudoaneurysm treated with endovascular flow diversion stenting. The patient was a 27-year-old male who was involved in a motorcycle accident suffering multiple traumatic injuries including a large skull base fracture that extended through the carotid canal. Computed tomography angiography revealed a 2-cm right ICA pseudoaneurysm. Once the patient was stable, a digital subtraction angiography demonstrated enlargement of the pseudoaneurysm. After his other injuries were addressed by trauma and orthopedic surgery, at day 9 after his initial injury, the patient was loaded with aspirin and clopidrogel in preparation for stent reconstruction of his ICA injury. Under conscious sedation and systemic heparinization, the patient underwent endovascular reconstruction of the large pseudoaneurysm using telescoping flow diversion stents. Immediate intra-aneurysm flow stasis was observed. No procedure-related complications occurred. The patient did well and at last follow-up remained neurologically intact.

Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus

BackgroundInternal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis. ObjectiveThis study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus. MethodsVarious data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017. ResultsThe patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients. ConclusionICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.

Emergency high-flow bypass for the management of ruptured postirradiated internal carotid artery pseudoaneurysms in nasopharyngeal carcinoma patients

Abstract Rupture of a postirradiated internal carotid artery (ICA) pseudoaneurysm in patients with nasopharyngeal carcinoma (NPC) is a rare yet life-threatening emergency. In contrast to pseudoaneurysms found in patients with other head and neck malignancies, those identified in NPC patients have a propensity to occur in the petrous segment of the ICA, which pose a serious challenge to clinical physicians. Over the past few decades, endovascular treatment with covered stents has widely been adopted as the treatment of choice for patients at risk of brain ischemia after occluding the parent vessel of the pseudoaneurysm. Although recent series have demonstrated that immediate hemostasis can be achieved in most of the patients undergoing covered stent placement, a high incidence of delayed complications has been reported, including delayed cerebral ischemia, in-stent thrombosis, and septic thromboembolism. We present two NPC patients with a postirradiated pseudoaneurysm involving the petrous segment of the internal carotid artery. As direct parent vessel occlusion was infeasible, we established an emergency high-flow extracranial-intracranial (EC-IC) bypass followed by endovascular parent vessel occlusion. Both of the patients were followed-up for more than 24 months without neurological deficit or rebleeding. We suggest that EC-IC bypass with parent vessel occlusion should be considered as a practical and durable treatment option for patients with postirradiated ICA pseudoaneurysms who cannot tolerate direct carotid occlusion.

Delayed Endovascular Coil Extrusion Presenting as a Foreign Body of the Throat: a Case Report.

Endovascular treatment is a standard mode of treatment for traumatic cavernous internal carotid artery (ICA) pseudoaneurysms with good results and relatively low rates of complications. We describe a case of an unusual, potentially fatal, delayed postoperative event happening in a case of post-traumatic pseudoaneurysm of ICA, which had been previously managed with endovascular coiling.

A rare and fatal complication of ear syringing: Rupture of pseudoaneurysm at petrous internal carotid artery

Ear syringing is a common procedure done for cleaning wax from the ear canal. Rupture of the pseudoaneurysm at the petrous part of the internal carotid artery (ICA) due to ear syringing is an extremely rare incidence in clinical practice. Sudden and profuse bleeding from the ear is the clinical presentation in case of ruptured pseudoaneurysm of ICA at the petrous part. Presence of the cholesteatoma at the middle ear cleft may be an etiology causing rupture of the pseudoaneurysm at the petrous part of the ICA, but the forceful ear syringing is an uncommon cause for the rupture of pseudoaneurysm. Radiological imaging is an important tool for the diagnosis. Endovascular technique is often used for the treatment of pseudoaneurysm of the ICA. Here, we are reporting an uncommon complication of forceful ear syringing making rupture of the pseudoaneurysm of petrous ICA leading to fatal spontaneous and profuse bleeding from the ear.

Mild Traumatic Brain Injury Associated with Internal Carotid Artery Dissection and Pseudoaneurysm.

Mild Traumatic Brain Injury Associated with Internal Carotid Artery Dissection and Pseudoaneurysm.

Delayed migration of coil into the nasopharynx following embolization of internal carotid artery pseudoaneurysm: A rare complication.

Delayed migration of coil into the nasopharynx following embolization of internal carotid artery pseudoaneurysm: A rare complication.

Endovascular management of internal carotid artery pseudoaneurysms: A single-centre experience of 20 patients

Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) are uncommon lesions. Various surgical and endovascular options are available for the management of these lesions. We describe our experience in using a spectrum of endovascular management strategies for ICA-PSA and present their outcome. To evaluate the role and efficacy of endovascular intervention in the management of ICA PSA. The clinical and angiographic data of 20 ICA PSAs from January 2008 till July 2016 were reviewed retrospectively. A meticulous evaluation of all the patients regarding their clinical symptoms, imaging findings (Ultrasound Doppler/CTA/MRI) and the endovascular techniques was performed. Clinical and imaging follow up for at least 1 year was also assessed. There were 15 (75%) male and 5 (25%) female patients, with their age ranging from 11 months to 60 years. Eleven patients (55%) were of the paediatric age group. PSAs were seen in the cervical ICA in 12 patients (60%) and in the intracranial ICA in 8 patients (40%). The most common causes of PS formation were iatrogenic (n = 8), followed by trauma (n = 7), and infection (n = 5). Parent artery occlusion was performed in 10 patients (50%), stenting in 7 patients (35%), and PSA coiling in 3 patients (15%). Immediate and complete obliteration of the PSAs was achieved in all cases without any major procedural complication. Recurrence was diagnosed at 2 years, in one patient who had undergone parent artery occlusion. This was successfully retreated. None of our patients had immediate or delayed major neurological deficits. Endovascular treatment provides a safe and minimally invasive management option in patients with ICA PSA. It helps in the prevention of rupture of the PS and also its thromboembolic complications.