J Korean Neurosurg Soc.  2020 Sep;63(5):590-597. 10.3340/jkns.2019.0202.

Covered Stenting Is an Effective Option for Traumatic Carotid Pseudoaneurysm with Promising Long-Term Outcome

• Wang K
• Peng Xx
• Liu Af
• Zhang Yy
• Lv J
• Xiang L
• Liu Ye
• Jiang Wj

• KMID: 2506022
• DOI: http://doi.org/10.3340/jkns.2019.0202

Abstract

Objective
: Covered stenting is an optional strategy for traumatic carotid pseudoaneurysm, especially in malignant conditions of potential rupture, but the long-term outcomes are not clear. Our aim was to determine if covered stenting is an effective option for traumatic carotid pseudoaneurysm with promising long-term outcomes.
Methods
: Self-expanding Viabahn and balloon-expandable Willis covered stents were separately implanted for extra- and intracranial traumatic carotid pseudoaneurysm. The covered stent was placed across the distal and proximal pseudoaneurysm leakage under roadmap guidance. Procedural success was defined as technical success (complete exclusion of the pseudoaneurysm and patency of the parent artery) without a primary end point (any stroke or death within 30 days after the procedure). Longterm outcomes were evaluated as ischemic stroke in the territory of the qualifying artery by clinical follow-up through outpatient or telephone consultation and as the exclusion of the pseudoaneurysm and patency of the parent artery by imaging follow-up through angiography.
Results
: Five patients with traumatic carotid pseudoaneurysm who underwent covered stenting were enrolled. The procedural success rate was 100%. No ischemic stroke in the territory of the qualifying artery was recorded in any of the five patients during a mean clinical follow-up of 44±16 months. Complete exclusion of the pseudoaneurysm and patency of the parent artery were maintained in all five patients during a mean imaging follow-up of 39±16 months.
Conclusion
: Satisfactory procedural and long-term outcomes were obtained, suggesting that covered stenting is an effective option for traumatic carotid pseudoaneurysm.

Keyword

Cerebrovascular trauma; Carotid artery injuries; Stents; Treatment outcome

Figure

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  Fig. 1. Bouthillier segment classification of the carotid artery and a diagrammatic sketch of a pseudoaneurysm and covered stent.

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  Fig. 2. Preoperative, immediate postoperative and follow-up angiographies of all five included cases.

Reference

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