Neurointervention.  2023 Mar;18(1):72-75. 10.5469/neuroint.2022.00409.

Fracture of a Flow Diverter in the Cervical Internal Carotid Artery Due to Eagle Syndrome

• Pfaff JAR
• Weymayr F
• Killer-Oberpflazer M

• KMID: 2539950
• DOI: http://doi.org/10.5469/neuroint.2022.00409

Abstract

In Eagle syndrome, elongated styloid processes may provoke internal carotid dissection and pseudoaneurysm causing stroke and data regarding possible complications or long-term results of pseudoaneurysm treatment using a flow diverter are limited. We report a case of a dissection-related pseudoaneurysm in the left cervical carotid artery treated by implantation of a flow diverter. Follow-up imaging of the flow diverter showed fracture of a continuous radiopaque marker at 3 months and fracture of a second continuous radiopaque marker at 7 months, while contrasting of the vessel was preserved. At the time of angiographic control (8 months after implantation), the flow diverter and the extracranial left internal carotid artery were occluded, and the patient did not experience any symptoms throughout the period.

Keyword

Ischemic stroke; Internal carotid artery dissection; Carotid artery injuries; Eagle syndrome

Figure

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  Fig. 1. Sagittal images of computed tomography (CT) angiography at first presentation of a patient with minor stroke showing the elongated styloid process (asterisk) and a caliber reduction of the left internal carotid artery (ICA) secondary to dissection. (A) The blank arrows indicate the proximal and distal entry of the dissection, later to become the pseudoaneurysm. (B) Contrast-enhanced magnetic resonance angiography (posteroanterior [PA] view) of the left ICA showing a pseudoaneurysm after 6 months. Digital subtraction angiography (DSA) image of the left carotid artery pseudoaneurysm before (C) and corresponding non-subtracted angiography image after (D) implantation of the flow diverter. Coronal multiplanar reconstruction of flat-panel CT with intravenous contrast: on day 1 (E), at 3 months (F), and at 7 months (G) after flow diverter implantation. Note: despite the implanted flow diverter, the pseudoaneurysm still fills with contrast agent (E–G). (H) Coronal multiplanar reconstruction of flat-panel CT after intra-arterial contrast medium injection in the left ICA at 8 months after implantation. The white arrows on the follow-up images indicate the fractured and retracted distal radiopaque struts of the flow diverter. (I) DSA image (PA view) of the flow diverter 8 months after implantation showing occlusion of the device and the ICA. Single shot X-ray of the fractured flow diverter in PA (J) and lateral view (K). The black arrows point to fragments of the radiopaque struts of the flow diverter.

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