Neurointervention.  2018 Mar;13(1):54-57. 10.5469/neuroint.2018.13.1.54.

Symptomatic Post Endarterectomy Common Carotid Artery Pseudoaneurysm Treated with Combination of Flow Diverter Implantation and Carotid Stenting

• Young M
• Imbarrato
• Gordhan A

• KMID: 2424050
• DOI: http://doi.org/10.5469/neuroint.2018.13.1.54

Abstract

A 74-year-old male developed cervical carotid artery psuedoaneurysm 8 months after carotid endarterectomy. The patient was successfully managed with dual implantation of flow-diverter and conventional carotid stent. Flow-diverter was placed across the neck of pseudoaneurysm to provide flow diversion while carotid stent was implanted within the lumen of the expanded flow-diverter to approximate and hold the flow diverter proximal and distal to the pseudoaneurysm. Follow-up ultrasonography revealed complete resolution of the pseudoaneurysm.

Keyword

Carotid endarterectomy; Flow diverter; Postsurgical pseudoaneurysm

MeSH Terms

Aged
Aneurysm, False*
Carotid Arteries
Carotid Artery, Common*
Endarterectomy*
Endarterectomy, Carotid
Follow-Up Studies
Humans
Male
Neck
Stents*
Ultrasonography

Figure

• 

  Fig. 1 Axial (A) and coronal oblique (B) neck CTA demonstrating a pseudoaneurysm deep to the mandibular angle at the distal endarterectomy anastomotic site (solid arrows). Post patch placement ectasia of the carotid bifurcation proximal to the pseudoaneurysm is noted (dotted arrow).

• 

  Fig. 2 (A) Digital subtraction angiography (DSA) of the right common carotid artery demonstrates a laterally projection broad neck 18 mm×16 mm×12 mm pseudoaneurysm (solid arrow) with marked disparate caliber of the extracranial carotid artery proximal and distal to the endarterectomy graft site (dotted arrow). (B) The overlapped dual device construct (dotted arrow) with significant stasis within the pseudoaneurysm (solid arrow). (C) DSA post flow device and carotid stent placement demonstrating stasis in the pseudoaneurysm with patency of the external carotid artery. (D) Carotid duplex color doppler sonography demonstrating the overlapped dual device artifact (dotted arrow) with complete resolution of the pseudoaneurysm (solid arrow).

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