Endovascular Repair of an Infected Broken Pseudoaneurysm of the Extracranial Internal Carotid Artery

Claude Michel, Alain Parot, Patrick Jue Denis, Pierre-Yves Laffy, Jean-Yves Riou, Gilbert Leblanc

Cardio-Vascular Radiology Department, Marie Lannelongue Hospital, Le Plessis Robinson, France.
Vascular Radiology Department, Europe Medico-Surgical Center, Le Port Marly, France.
Vascular Surgery Department, Europe Medico-Surgical Center, Le Port Marly, France.

DOI: 10.4236/ojrad.2012.24020                

Abstract

The formation of pseudoaneurysms after carotid endarterectomy is extremely rare. Treating those pseudoaneuryms is necessary because of the risks for continued expansion, rupture and distal embolism. Traditional surgical repair of carotid artery pseudoaneurysms is associated with a high morbidity and mortality. An endovascular approach to these infected pseudoaneurysms limits the risk for operative damage to surrounding structures and potential blood loss.

Keywords

Carotid Artery; Pseudoaneurysm; Covered Self Expandable Stent

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. C. Schechter, “Cervical Carotid Aneurysms, Part I,” New York State Journal of Medicine, Vol. 79, No. 6, 1979, pp. 892-901.
[2]	Q. Zhang, Z. Q. Duan, S. J. Xin, X. W. Wang and Y. T. Dong, “Management of Extracranial Carotid Artery Aneuysms: 17 Years’ Experience,” European Journal of Vascular and Endovascular Surgery, Vol. 18, No. 2, 1999, pp. 162-165.
[3]	G. L. Faggioli, A. Freyrie and A. Stella, “Extracranial Internal Carotid Artery Aneurysms: Results of a Surgical Series with Long-Term Follow-Up,” Journal of Vascular Surgery, Vol. 23, No. 4, 1996, pp. 587-594. doi:10.1016/S0741-5214(96)80037-1
[4]	E. Rosset, J. N. Albertini and P. E. Magnan, “Surgical Treatment of Extracranial Internal Carotid Artery Aneurysms,” Journal of Vascular Surgery, Vol. 31, No. 4, 2000, pp. 713-723. doi:10.1067/mva.2000.104102
[5]	C. D. Liapis, A. Gugulakis and E. Misiakos, “Surgical Treatment of Extracranial Carotid Aneurysms,” International Journal of Angiology, Vol. 13, No. 4, 1994, pp. 290-295.
[6]	C. L. Branch and C. H. Davis Jr., “False Aneurysm Complicating Carotid Endarterectomy,” Neurosurgery, Vol. 19, No. 3, 1986, pp. 421-425. doi:10.1227/00006123-198609000-00014
[7]	C. A. Fernandez, S. Tagarro, C. G. Lozano-Arnilla, et al., “Internal Carotid Pseudoaneurysm within a Parapharygeal Infection: An Infrequent Complication of Difficult Diagnosis,” Otolaryngology—Head and Neck Surgery, Vol. 132, No. 4, 2005, pp. 671-673. doi:10.1016/j.otohns.2004.09.025
[8]	R. El-Sabrout and D. A. Cooley, “Extracranial Carotid Artery Aneurysms: Texas Heart Institute Experience,” Journal of Vascular Surgery, Vol. 31, No. 4, 2000, pp. 702-712. doi:10.1067/mva.2000.104101
[9]	R. El-Sabrout, G. Reul and D. A. Cooley, “Infected Postcaritid Endarterectomy Pseudoaneurysms: Retrospective Review of a Series,” Annals of Vascular Surgery, Vol. 14, No. 3, 2000, pp. 239-247. doi:10.1007/s100169910041
[10]	A. L. James, S. O’Malley and C. A. Milford, “Extracranial Internal Carotid Artery Aneurysm in a Child: A Diagnostic and a Surgical Challenge,” The Journal of Laryngology & Otology, Vol. 113, No. 4, 1999, pp. 373375. doi:10.1017/S0022215100144020
[11]	T. Skau, J. Hillman, H. Harder and B. Magnuson, “Surgical Treatment of a Distal, Extracranial, Internal Carotid Artery Aneurysm Involving the Base of the Skull—A Multidisciplinary Approach,” European Journal of Vascular and Endovascular Surgery, Vol. 20, No. 3, 2000, pp. 308-311. doi:10.1053/ejvs.2000.1108
[12]	S. Tanaka, Y. Kimura and M. Furukawa, “Pseudoaneurysm of the Carotid Artery with Haemorrhage into the Hypopharynx,” The Journal of Laryngology & Otology, Vol. 109, 1995, pp. 889-891. doi:10.1017/S0022215100131603
[13]	R. L. Bush, P. H. Lin, J. R. Laird, et al., “Endoluminal Stent Placement and Coil Embolization for the Management of Carotid Artery Pseudoaneurysms,” Journal of Endovascular Therapy, Vol. 8, No. 1, 2001, pp. 53-61. doi:10.1583/1545-1550(2001)008<0053:ESPACE>2.0.CO;2
[14]	M. J. Perez-Cruet, R. V. Patwardhan, M. E. Mawad and J. E. Rose, “Treatment of Dissecting Pseudoaneurysm of the Cervical Internal Carotid Artery Using a Wall Stent and Detachable Coils: Case Report,” Neurosurgery, Vol. 40, No. 3, 1997, pp. 622-625.
[15]	R. Holder, D. Hilton, J. Martin, et al., “Percutaneous Thrombin Injection of Carotid Artery Pseudoaneurysm,” Journal of Endovascular Therapy, Vol. 9, No. 1, 2002, pp. 25-28. doi:10.1583/1545-1550(2002)009<0025:PTIOCA>2.0.CO;2
[16]	K. F. Layton, Y. W. Kim and J. H. Hise, “Use of Covered Stent Grafts in the Extracranial Carotid Artery: Report of Three Patients with Follow-Up between 8 and 42 Months,” American Journal of Neuroradiology, Vol. 25, No. 10, 2004, pp. 1760-1763.
[17]	D. T. Baril, S. H. Ellozy, A. Carroccio, A. B. Patel, R. A. Lookstein and M. L. Marin, “Endovascular Repair of an Infected Carotid Artery Pseudoaneurysm,” Vol. 40, No. 5, 2004, pp. 1024-1027. doi:10.1016/j.jvs.2004.08.019
[18]	D. A. Troutman, C. R. Mohan, F. A. S amhouri and R. L. Sohn, “Endovascular Repair of Carotid Artery Pseudoaneurysm after Carotid Endarterectomy with Self-Expanding Covered Stents—A Long-Term Follow up,” Annals of Vascular Surgery, Vol. 24, No. 7, 2010, pp. 954.e13-16.
[19]	J. May, G. H. White, R. Waugh and J. Brennan, “Endoluminal Repair of Internal Carotid Artery Aneurysm: A Feasible but Hazardous Procedure,” Journal of Vascular Surgery, Vol. 26, No. 6, 1997, pp. 1055-1060. doi:10.1016/S0741-5214(97)70020-X
[20]	Y. Kadkhodayan, C. P. Derdeyn, D. T. Cross and C. J. Moran, “Procedure Complicatios of Carotid Angioplasty and Stent Placement without Cerebral Protection Devices,” Neurosurgical Focus, Vol. 18, No. 4, 2005, pp. 1-7. doi:10.3171/foc.2005.18.1.2
[21]	D. L. Bhatt, S. R. Kapadia, C. T. Bajzer, et al., “Dual Antiplatelet Therapy with Clopidogrel and Aspirin after Carotid Artery Stenting,” Journal of Invasive Cardiology, Vol. 13, No. 12, 2001, pp. 767-771.
[22]	B. K. Lal, R. W. Hobson 2nd and J. Goldstein, et al., “In-Stent Recurrent Stenosis after Carotid Artery Stenting: Life Table Analysis and Clinical Relevance,” Journal of Vascular Surgery, Vol. 38, No. 6, 2003, pp. 1162-1168. doi:10.1016/j.jvs.2003.08.021
[23]	I. Saatci, H. S. Cekirge, M. H. Ozturk, et al., “Treatment of Internal Carotid Artery Aneurysms with a Covered Stent: Experience in 24 Patients with Mid-Term Results,” American Journal of Neuroradiology, Vol. 25, No. 10, 2004, pp. 1742-1749.
[24]	K. Hosoda, S. Fujita, T. Kawaguchi, Y. Shibata and N. Tamaki, “The Use of an Extracranial-Internal Shunt in the Treatment of Extracranial Internal Carotid Artery Saccular Aneurysms: Technical Case Report,” Surgical Neurology, Vol. 52, No. 2, 1999, pp. 153-155. doi:10.1016/S0090-3019(99)00039-7