Peripheral Vascular Surgery Society

#20 ENDOLUMINAL STENT PLACEMENT AND COIL EMBOLIZATION FOR THE MANAGEMENT OF CAROTID ARTERY PSEUDOANEURYSMS.

Ruth L. Bush, MD, Peter H. Lin, MD, Thomas F. Dodson, MD, Jacques E. Dion, MD, and Alan B. Lumsden, MD

Emory University Hospital, Atlanta, GA.

Purpose: Carotid artery pseudoaneurysms are rare, often following blunt or penetrating trauma. For treatment of pseudoaneurysms in proximity to the skull base, traditional therapy has usually included long-term anticoagulation with or without complex surgical repair. The authors present a series of 4 patients who were treated by an endovascular approach with successful pseudoaneurysm obliteration.

Methods: Pseudoaneurysms identified by carotid angiography after appearance of neurologic symptoms not explained by computed tomography of the head were treated with endovascular stent placement (3Wallstent, 1 Palmaz). Subsequent to exclusion of the pseudoaneurysm, the cavity was filled with multiple detachable coils. Patients were maintained on oral antiplatelet agents following the procedure. Follow-up angiograms were obtained.

Results: From April 1995 to July 1999, 4 patients were identified with carotid artery pseudoaneurysms. Two patients had sustained blunt trauma and 2 had had previous carotid endarterectomies. The time between injury and treatment ranged from 1 day to 27 months. Primary technical success was 100%. No patient suffered permanent neurologic sequelae as a result of the endovascular procedure. Post-procedure angiography demonstrated a patent carotid artery in all cases with complete obliteration of the pseudoaneurysm. Long-term follow-up (mean 20 mos., range 21-27) angiograms in 3 patients demonstrated continued carotid artery patency. One patient who was asymptomatic had a 60% focal narrowing of the distal common carotid artery, which was treated successfully with balloon dilation and stenting.

Conclusion: Endovascular treatment of carotid artery pseudoaneurysms is a useful alternative to standard surgical technique repair. This modality avoids the necessity for surgical exposure at the skull base with its inherent morbidity.

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Last updated January 1,2000