J Cerebrovasc Endovasc Neurosurg.  2022 Sep;24(3):257-262. 10.7461/jcen.2022.E2021.06.005.

Use of covered stent (CGuard) in the treatment of post-traumatic internal carotid artery pseudoaneurysm

Affiliations
  • 1Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India

Abstract

Post-traumatic internal carotid artery pseudoaneurysm (ICA PSA) is a rare occurrence with high mortality rates, and with the advent of endovascular therapy, its treatment has shown drastic improvement in clinical as well as radiological outcomes. Here we are describing our experience with the CGuard embolic protection system (InspireMD, Tel Aviv, Israel) for the treatment of post-traumatic left ICA PSA in a 49-year-old male. New improved biomechanics and navigability have proven it to be a safe and efficient treatment modality for ICA PSA. However, a multicentric large-scale randomized trial is recommended to support this modality.

Keyword

CGUARD; Covered stent; Internal carotid artery pseudoaneurysm (ICA PSA); Post-traumatic pseudoaneurysm; Endovascular treatment; Double layer stent

Figure

  • Fig. 1. Pre-op CT angiography of neck vessels, (A) axial view and (B) coronal view with, (C) 3D reconstruction showing pseudoaneurysm (PSA) in extracranial part of the left internal carotid artery (ICA) shown with black arrows. CT, computed tomography

  • Fig. 2. Pre-op DSA of neck vessels, (A) anteroposterior view and (B) lateral view with, (C) 3D reconstruction showing pseudoaneurysm (PSA) in extracranial part of the left internal carotid artery (ICA) with kinking (black arrow) of ICA seen distal to bifurcation of common carotid artery (CCA) with dimensions of the PSA. DSA, digital subtraction angiography

  • Fig. 3. Intra-op DSA with (A) straightening of the ICA (black arrow) by Neuron Select guide catheter (Penumbra, Alameda, CA, USA) in-situ and, after (B) deployment of CGuard Stent (InspireMD, Tel Aviv, Israel) across pseudoaneurysm (white arrow). DSA, digital subtraction angiography; ICA, internal carotid artery

  • Fig. 4. Post-op stentogram (black arrow) with stasis in pseudoaneurysm (white arrow).

  • Fig. 5. Post-op CT angiography neck vessels, (A) coronal view and (B) sagittal view with, (C) 3D reconstruction showing complete exclusion of pseudoaneurysm with patent parent artery (black arrows). CT, computed tomography


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