Endovascular Occlusion of Cervical Internal Carotid Artery Pseudoaneurysm in a Child Treated by N-Butyl Cyanoacrylate: A Rare Case Report

Abstract

We report a rare case of spontaneous extracranial cervical internal carotid artery (ICA) pseudoaneurysm in a female child aged 3 years who presented with a swelling in the neck which had bled following an attempted incision as it had been thought to be an abscess. A CT angiogram and an MR angiogram were not very conclusive to diagnose the exact site of origin and the morphology of the aneurysm. Digital subtraction angiography revealed a dissecting pseudoaneurysm of the right extracranial cervical ICA. The right ICA was ending as a pseudosac, and the right cerebral circulation was filling up through the right posterior cerebral artery. To minimize the radiation exposure, a microcatheter was placed inside the diagnostic catheter. The aneurysm sac was occluded using N-butyl cyanoacrylate since there was no distal flow to the brain from the artery beyond the aneurysm. It was a safe, effective and cheaper alternative to open surgery or to other endovascular management options available. Not all neck swellings are abscesses, and they should be examined and evaluated to exclude a vascular cause.

Resection of a recurrent cervical internal carotid artery pseudoaneurysm after failed endovascular therapy

“…Other symptoms include transient ischemic attacks, amaurosis fugax, oral or nasal hemorrhage, neck pain, lower cranial nerve palsies, and Horner's syndrome. [ 11 ] CTA is the preferred imaging study for diagnosis of a pseudoaneurysm. [ 1 23 ]…”

“…[ 12 ] Endovascular therapy is the principal option for such lesions. [ 3 11 23 27 28 29 ] Recurrence of a pseudoaneurysm initially treated by endovascular means is rare. We report an instance where a patient returned with a recurrent, enlarging cervical ICA pseudoaneursym, 15 years after initial complete, endovascular occlusion of the vessel.…”

A rare case report of trauma manifesting as multiple pseudoaneurysms of internal carotid artery and ipsilateral carotid cavernous fistula

“…Cervical ICA pseudoaneurysm is mostly managed by stenting, rarely coil, nactacryl or Onyx-HD embolization due to fragile wall [2,8,[10][11][12]. Traditionally aneurysms are given priority over fistulous closure even if they are clinically silent.…”

Nontraumatic Cervical Internal Carotid Artery Pseudoaneurysm in a 16-Month-Old Child Treated by Coil Embolization

“…Other novel methods used in treatment of these pseudoaneurysms include using n -butyl cyanoacrylate (glue) in a case of spontaneous ICA pseudoaneurysm in a 3-year-old child. 13 Intraaneurysmal thrombin injection is usually not done in carotid pseudoaneurysms due to the chances of recurrence and distal embolization. Complications following endovascular management include coil migration, recanalization of the pseudoaneurysm, and embolic stroke.…”