J Cerebrovasc Endovasc Neurosurg.  2024 Dec;26(4):399-404. 10.7461/jcen.2024.E2023.11.007.

Use of a new low-profile coronary stent graft for the treatment of intracranial carotid blow-out

• Altunbulak HI
• Altunbulak AY
• Balci S
• Berker M
• Arat A

• KMID: 2563089
• DOI: http://doi.org/10.7461/jcen.2024.E2023.11.007

Abstract

A 50-year-old male patient with a history of transcranial surgery and subsequent radiotherapy for a pituitary adenoma presented with repetitive pulsatile nasal bleeding. A right cavernous segment pseudoaneurysm was discovered on the angiogram, and the patient failed the balloon occlusion test. A Papyrus (Biotronik, Berlin, Germany) stent graft, which is approved for coronary interventions, was successfully deployed over a coaxial guiding system during the emergent treatment of the false aneurysm. The patient tolerated the procedure well and nasal bleeding did not recur after the procedure. At one-year angiographic follow-up, the stent graft was patent and there was no evidence of recanalization of the false aneurysm.

Keyword

Iatrogenic disease; Internal carotid artery; Internal carotid artery dissection; Endovascular procedures; Flow diversion; Epistaxis

Figure

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  Fig. 1. On 3D volume rendered image obtained from the rotational angiogram, a cavernous pseudoaneurysm is visible (red arrow) (A). The pseudoaneurysm (red arrow) in the internal carotid artery cavernous segment as demonstrated on a lateral view of the right internal carotid angiogram (B). Intracranial Access (C) was obtained using a quadraxial catheter system (blue arrow: tip of the Rebar 18 microcatheter, red arrow: 4 F 130 cm Fubuki guiding catheter, green arrow: 6F 115 cm Neurobridge guiding catheter, yellow arrow: guidewire within the microcatheter). The stent (yellow arrow) (D) was deployed by inflating the balloon at 5 atm (red arrow) (E). 3D volume rendered flat panel computed tomography images obtained during the 3-month follow-up angiogram (F), and lateral views of further follow-up angiograms at 7 (G) and 11 (H) months show no evidence of a residual aneurysm and patency of the stent graft (yellow arrow).

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