Covered Stenting Is an Effective Option for Traumatic Carotid Pseudoaneurysm with Promising Long-Term Outcome

Abstract

Objective : Covered stenting is an optional strategy for traumatic carotid pseudoaneurysm, especially in malignant conditions of potential rupture, but the long-term outcomes are not clear. Our aim was to determine if covered stenting is an effective option for traumatic carotid pseudoaneurysm with promising long-term outcomes. Methods : Self-expanding Viabahn and balloon-expandable Willis covered stents were separately implanted for extra-and intracranial traumatic carotid pseudoaneurysm. The covered stent was placed across the distal and proximal pseudoaneurysm leakage under roadmap guidance. Procedural success was defined as technical success (complete exclusion of the pseudoaneurysm and patency of the parent artery) without a primary end point (any stroke or death within 30 days after the procedure). Longterm outcomes were evaluated as ischemic stroke in the territory of the qualifying artery by clinical follow-up through outpatient or telephone consultation and as the exclusion of the pseudoaneurysm and patency of the parent artery by imaging follow-up through angiography. Results : Five patients with traumatic carotid pseudoaneurysm who underwent covered stenting were enrolled. The procedural success rate was 100%. No ischemic stroke in the territory of the qualifying artery was recorded in any of the five patients during a mean clinical follow-up of 44±16 months. Complete exclusion of the pseudoaneurysm and patency of the parent artery were maintained in all five patients during a mean imaging follow-up of 39±16 months. Conclusion : Satisfactory procedural and long-term outcomes were obtained, suggesting that covered stenting is an effective option for traumatic carotid pseudoaneurysm.

Case report: Traumatic carotid and vertebral arteries Pseudoaneurysm associated with vertebral arteriovenous fistula

“…At the present, surgical vascular reconstruction and endovascular aneurysm embolization are the two preferred treatments for carotid PSAs [6][7][8][9]. Conservative treatment of carotid PSAs resulted in a mortality rate of nearly 71% [10].…”

Traumatic brachial artery injury successfully treated with a stent-graft: A case report

“…3 The device enables hemostasis and reconstruction simultaneously with endovascular surgery. The efficacy of the device in peripheral arterial trauma has been reported in injuries of the subclavian arteries, 2 axillary arteries, 4 carotid arteries, 5 and visceral arteries. 3 In a stenotic lesion in a chronic renal failure patient, although it is not a vascular injury, this device has been reported in its safety placement in the upper limb as well.…”

Willis Covered Stent for Treating Intracranial Pseudoaneurysms of the Internal Carotid Artery: A Multi-Institutional Study

“…Endovascular treatments include a "destructive strategy" (sacrifice of the parent artery) and a "reconstructive strategy" (preservation of the parent artery). 11 With the growing popularity of special intracranial stents, reconstruction approaches have been increasingly critical for the treatment of pseudoaneurysms. Aneurysm sac packing utilizing coils, balloons or fluids has been applied to preserve parent artery patency, but pseudoaneurysm rupture likely occurs during the procedure due to the lack of true vessel wall.…”