Covered Stent Deployment and Follow-Up of a Case of Internal Carotid Artery Pseudoaneurysm

2003 ◽  
Vol 16 (1) ◽  
pp. 98-101 ◽  
Author(s):  
T. Lupattelli ◽  
F.G. Garaci ◽  
C.E.O. Hopkins ◽  
G. Simonetti
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Covered Stent ◽  
Stent Deployment ◽  
Artery Pseudoaneurysm

scholarly journals The Clinical Efficacy Analysis of Treatment With a Willis Covered Stent in Traumatic Pseudoaneurysm of the Internal Carotid Artery

2021 ◽  
Vol 12 ◽  
Author(s):  
Yueyuan Zhao ◽  
Zhiwen Liu ◽  
Ronghui Sun ◽  
Li Pan ◽  
Ming Yang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Implantation ◽  
Internal Carotid ◽  
Covered Stent ◽  
Covered Stents ◽  
Multicenter Studies ◽  
Stent Deployment ◽  
Traumatic Pseudoaneurysm

Objective: To investigate the safety and efficacy of Willis covered stents (WCS) in the treatment of traumatic pseudoaneurysm of the cranial internal carotid artery (CICA).Methods: Fifteen patients with traumatic pseudoaneurysm of the intracranial segment of the ICA treated with the WCS system at our institution from 2013 to 2019 were analyzed retrospectively. Follow-up observation and digital subtraction angiography (DSA) examination were conducted ~6 months after the treatment.Results: DSA performed immediately after stent deployment revealed that complete occlusion of the lesion was achieved in 13 patients and that endoleak occurred in two patients. In 12 patients, postoperative DSA examination indicated that the lesions were completely occluded. In two patients who had a second stent implantation at the break of the ICA, traumatic ICA rupture was essentially completely obstructed in 1 patient. The endoleak remained in one patient with carotid cavernous sinus fistula because the placement of the second stent system was difficult with his ICA tortuosity. No recurrence of aneurysms, hemorrhage, or other lesions was observed, and the patients' parent arteries were patent without stenosis. No procedure-related complications or ischemic strokes occurred during the follow-up period of ~6 months.Conclusions: For treatment of traumatic pseudoaneurysm of the CICA, Willis covered stent implantation in some appropriate cases, is safe and effective. However, large-sample controlled studies and multicenter studies are needed for further confirmation.

scholarly journals Equine pericardium-covered stenting in post-traumatic pseudoaneurysm of cavernous internal carotid artery

2018 ◽  
Vol 24 (6) ◽  
pp. 635-638
Author(s):  
Jorge L Gonzalez-Cantero ◽  
Mariano del Valle Diéguez ◽  
Cristina Monteserín Matesanz ◽  
Javier Saura Lorente ◽  
Francisco Villoria Medina ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Covered Stent ◽  
Parent Vessel ◽  
Artery Pseudoaneurysm ◽  
Equine Pericardium ◽  
Post Traumatic

We report a case of traumatic intracranial carotid artery pseudoaneurysm treated with an equine pericardium-covered stent. The patient was admitted to the Emergency Department after sustaining severe polytrauma in a motor vehicle accident. A cavernous carotid pseudoaneurysm was detected after an episode of massive epistaxis that required emergent nasal packing. Treatment with parent vessel sacrifice was ruled out after an unfavourable balloon test occlusion. We opted for an equine pericardium-covered stent as a means to immediately seal the wall defect in the setting of massive bleeding secondary to an unstable lesion. We describe the potential benefits and drawbacks of these prostheses and the technical difficulties encountered in this particular case. To our best knowledge, this is the first published case report on a post-traumatic intracranial internal carotid artery pseudoaneurysm successfully treated with an equine pericardium-covered stent.

Reconstructive endovascular treatment of ruptured blood blister–like aneurysms of the internal carotid artery

2009 ◽  
Vol 110 (3) ◽  
pp. 431-436 ◽  
Author(s):  
Byung-Hee Lee ◽  
Byung Moon Kim ◽  
Moon Sun Park ◽  
Sung Il Park ◽  
Eun Chul Chung ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Scale Score ◽  
Stent Placement ◽  
Glasgow Outcome Scale ◽  
Internal Carotid ◽  
Covered Stent ◽  
Stent Insertion ◽  
Endovascular Methods

Object Ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. Methods Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42–57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. Results All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4–26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. Conclusions In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.

scholarly journals Jostent covered stent placement for emergency reconstruction of a ruptured internal carotid artery during or after transsphenoidal surgery

2015 ◽  
Vol 122 (5) ◽  
pp. 1223-1228 ◽  
Author(s):  
Byung Moon Kim ◽  
Pyoung Jeon ◽  
Dong Joon Kim ◽  
Dong Ik Kim ◽  
Sang Hyun Suh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Covered Stent ◽  
Active Bleeding ◽  
Covered Stents ◽  
Surgical Suture

OBJECT Internal carotid artery (ICA) rupture during transsphenoidal surgery (TSS) is an extremely difficult complication to treat. This study aimed to evaluate the immediate and long-term outcomes of covered stent placement for emergency reconstruction of ruptured ICAs during or after TSS. METHODS Seven patients underwent covered stent placement for emergency reconstruction of a ruptured ICA during or after TSS. The safety and effectiveness of covered stent placement for emergency reconstruction of ruptured ICAs were retrospectively analyzed. RESULTS Pretreatment angiography showed active bleeding in 6 patients (5 intraoperative and 1 postoperative) and a pseudoaneurysm in 1 patient. Of the 6 patients with active bleeding, 5 were treated with a successive operation to control active bleeding. The other patient was treated just after cardiopulmonary resuscitation due to massive nasal bleeding 20 days after revision of TSS. All active bleeding was controlled immediately after covered stent insertion in these 6 patients. One patient showed a gap between the covered stent and ICA wall without active bleeding 30 minutes after glycoprotein IIb/IIIa inhibitor administration due to in-stent thrombosis. The gap was occluded with coil embolization after completion of the temporarily suspended TSS. The seventh patient, whose ICA tear was treated with surgical suture, underwent covered stent placement for a pseudoaneurysm detected on postoperative Day 2. During a mean follow-up period of 46 months (range 12–85 months), all patients had excellent outcomes (modified Rankin Scale score of 0). All the stented ICAs were patent on vascular imaging follow-up at a mean of 34 months (range 12–85 months). CONCLUSIONS Covered stents appear to be a safe and effective option for emergency reconstruction of ruptured ICAs during or after TSS.

Autologous Vein-covered Stent Repair of a Cervical Internal Carotid Artery Pseudoaneurysm: Technical Case Report

Neurosurgery ◽  
1998 ◽  
Vol 42 (2) ◽  
pp. 408-413 ◽  
Author(s):  
Thomas R. Marotta ◽  
Christopher Buller ◽  
David Taylor ◽  
Christopher Morris ◽  
Thomas Zwimpfer
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Covered Stent ◽  
Autologous Vein ◽  
Artery Pseudoaneurysm ◽  
Cervical Internal Carotid Artery

Treatment of an Iatrogenic Petrous Carotid Artery Pseudoaneurysm with a Symbiot Covered Stent: Technical Case Report

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 658-662 ◽  
Author(s):  
Michael J. Alexander ◽  
Tony P. Smith ◽  
Debara L. Tucci
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Temporal Bone ◽  
Middle Ear ◽  
Internal Carotid ◽  
Covered Stent ◽  
Tube Placement ◽  
Boston Scientific ◽  
Artery Pseudoaneurysm ◽  
Expanded Polytetrafluoroethylene

Abstract OBJECTIVE AND IMPORTANCE: Surgery involving the middle ear or the temporal bone may cause an injury to the petrous carotid artery resulting in a pseudoaneurysm. Conventional treatment of such pseudoaneurysms has ranged from carotid occlusion to conservative management. The use of a balloon-expandable stent and/or Guglielmi detachable coils may be effective in a partially healed pseudoaneurysm. This report details the case of an acute petrous carotid pseudoaneurysm after a myringotomy procedure that was effectively treated with an expanded polytetrafluoroethylene-covered stent. CLINICAL PRESENTATION: During a right myringotomy procedure, pulsatile blood was encountered in a 42-year-old woman with a history of repeated ear infections and bilateral middle ear ventilation tube placement. The blood was adequately tamponaded with gauze packing. Computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and cerebral angiography revealed a 6-mm right petrous carotid pseudoaneurysm. INTERVENTION/TECHNIQUE: An 8-French guide catheter was positioned via a transfemoral approach into the cervical right internal carotid artery, and the patient was systemically heparinized. A 4- × 31-mm Symbiot covered stent (Boston Scientific/Scimed, Maple Grove, MN) was passed over a Choice PT exchange wire (Boston Scientific/Scimed) to cover the neck of the pseudoaneurysm, obliterating the pseudoaneurysm. The patient was given aspirin and clopidogrel after stenting, and ear exploration was possible later the same day. Follow-up computed tomographic angiography performed 6 weeks later verified patency of the stent. CONCLUSION: The use of an expanded polytetrafluoroethylene-covered stent may effectively treat intracranial internal carotid artery pseudoaneurysms in an acute setting. This treatment allows preservation of the parent artery and immediate treatment by reconstruction of the incompetent arterial wall to prevent potentially life-threatening hemorrhagic complications.

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