Endovascular treatment of post-pharyngitis internal carotid artery pseudoaneurysm with a covered stent in a child: a case report

Requejo, Flavio; Sierre, Sergio; Lipsich, José; Zúccaro, Graciela

doi:10.1007/s00381-013-2083-y

Cited by 17 publications

(20 citation statements)

References 26 publications

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“…This is especially important to remember when examining pediatric patients, as this is the most common cause of extracranial carotid artery aneurysms in children. This is due to a higher incidence of lymphadenitis based on pharyngeal infections (e.g., tonsillitis, pharyngitis) (9, 20). Furthermore, IA has been reported in relation to Lemierre's syndrome both due to Fusobacterium and methicillin-resistant staphylococcus aureus (21).…”

Section: Discussionmentioning

confidence: 99%

Infected “Mycotic” Aneurysm of the Common Carotid Artery—A Differential Diagnosis to Tumor of the Neck

2018

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Introduction: Infected “mycotic” Aneurysm (IA) of the extracranial carotid artery is a rare condition that can be fatal if mistaken for other pathology. An 83-year-old man presented with a mass on the neck initially suspected malignant. Weeks later it grew rapidly and was found to be an IA, thus requiring acute surgery. Via this case report, we discuss diagnostics and approach when diagnosing masses in relation to vessels of the neck not readily explained.Case Report: After diagnostic imaging and clinical assessment an unknown primary tumor of the neck was suspected. Fine needle aspiration was inconclusive. The patient did not present with any signs of infection or neurological symptoms—only discomfort and pain. Approximately two weeks later, the mass grew and the patient became dysphagic, febrile, and confused. Computed tomography angiography revealed an IA of the right common carotid artery. The patient underwent acute surgery consisting of ligation of the internal and external carotid arteries and resection of the internal jugular vein. The pathogen found was E. coli, supposedly from the bladder after surgical intervention due to polyposis.Conclusion: IA is a very rare entity and can have many etiologies. Since it can be fatal, it is necessary to keep IA in mind when diagnosing masses in relation to vessels of the neck. As shown in this case of a E. coli-induced IA, patients can present with atypical symptoms, on diagnostic imaging it can be mistaken for other pathology, and pathogenesis can be unclear.

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Section: Discussionmentioning

confidence: 99%

Infected “Mycotic” Aneurysm of the Common Carotid Artery—A Differential Diagnosis to Tumor of the Neck

2018

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“…ICA occlusion is an option if the patient passes a balloon test occlusion (BTO) or in the backdrop of life-threatening hemorrhage;[ 16 25 ] nevertheless, 5–22% of patients may still sustain an ischemic stroke; moreover, a potential risk is the development of an anterior communicating artery aneurysm due to the crossed flow augmentation. [ 21 ] If the patient fails the BTO, an extracranial–intracranial bypass is an option, which can be accompanied by surgical or endovascular entrapment. [ 15 ] Resection of the cervical ICA pseudoaneurysm followed by end-to-end anastomosis has also been implemented.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Background:Recurrence of a cervical internal carotid artery (ICA) 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 ICA.Case Description:Patient is a 64-year-old male with a history of a right cervical ICA pseudoaneurysm diagnosed 15 years ago after a car accident. At the time, he received endovascular occlusion of his right ICA. Recent serial imaging demonstrated progressive enlargement of his pseudoaneurysm, up to 6 cm × 5 cm × 5.5 cm, without evidence of internal flow or extravasation. Due to dysphagia and hoarseness, resection of the pseudoaneurysm was recommended. Dissection occurred down to the lesion, where its borders were skeletonized. Its stump at the proximal ICA was mobilized and clamped; the lesion was incised and the existing thrombus, as well as the coil mass, was removed. The distal ICA appeared completely scarred with no retrograde filling. There were branches from the external carotid artery that appeared to supply the pseudoaneurysm. The scarred remnant of the distal ICA was sutured and the stump at the proximal ICA was ligated. Once hemostasis was obtained, closure occurred via anatomical layers. Postoperatively, the patient woke up well; at discharge, he exhibited no respiratory distress or dysphagia. At 5 months follow-up, a computed tomography angiography of the neck revealed no evidence for a residual pseudoaneurysm. He continues on lifelong aspirin.Conclusion:Recurrence of a cervical ICA pseudoaneursym is rare. We caution that such a clinical scenario is possible, even 15 years after endovascular occlusion of the ICA. Branches from the external carotid artery may feed the pseudoaneursym and cause recurrence. This mechanism has not been reported. Perhaps longer clinical follow-up is necessary, especially if endovascular therapy is the initial treatment option.

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“…One case report describing successful deployment of a covered stent for treatment of an infected pseudoaneurysm demonstrated patency of the stent at 18-month follow-up. 10 Others have reported the use of concomitant saccular coiling with stent-graft placement as a means to reduce mass effect from the aneurysm on the ICA. 11 Overall, covered stent placement appears to be a viable option for treatment of these pseudoaneurysms, especially in patients with poor intracranial collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of an infected pseudoaneurysm secondary to retropharyngeal abscess in a child

et al. 2015

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We describe a rare case of carotid pseudoaneurysm secondary to a retropharyngeal abscess, treated with coil embolization in a 2-year-old boy. The patient presented to an emergency department with symptoms suggesting meningitis but was subsequently diagnosed with streptococcal pharyngitis. He was discharged home on oral antibiotics after a short hospitalization. He returned to the emergency department two weeks later with limited neck motion and pain. Neck CT demonstrated a retropharyngeal abscess with a large left cervical internal carotid artery (ICA) pseudoaneurysm. The petrous ICA distal to the pseudoaneurysm had thrombosed prior to treatment. The ICA proximal to the pseudoaneurysm was sacrificed with coil embolization. Post-treatment imaging demonstrated complete thrombosis of the pseudoaneurysm but also demonstrated acute strokes in the left MCA/ACA watershed distribution. His parents noted that the patient was clumsier and exhibited some mild speech changes and a steppage gait prior to evaluation in the ED; therefore, these were thought to be secondary to emboli from partial thrombosis of the pseudoaneurysm prior to treatment. The patient was discharged home in good condition and his neurological function improved.

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Endovascular treatment of post-pharyngitis internal carotid artery pseudoaneurysm with a covered stent in a child: a case report

Abstract: Covered stents might be considered as a valid therapeutic option to treat carotid artery pseudoaneurysms.

Cited by 17 publications

References 26 publications

Infected “Mycotic” Aneurysm of the Common Carotid Artery—A Differential Diagnosis to Tumor of the Neck

Infected “Mycotic” Aneurysm of the Common Carotid Artery—A Differential Diagnosis to Tumor of the Neck

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

Endovascular treatment of an infected pseudoaneurysm secondary to retropharyngeal abscess in a child

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