False Aneurysms Complicating Internal Carotid Artery Dissection

Abstract

Pseudoaneurysm formation is a rare but dangerous complication of carotid artery dissection. It can result from trauma, spontaneous artery dissection, or iatrogenic causes. Presence of symptoms and ineffective medical therapy are one of the indications for invasive treatment. We present the case of 3 symptomatic patients with dissecting pseudoaneurysms-2 traumatic and 1 spontaneous. They were treated with 3 different endovascular procedures: the use of covered stentgraft, trans-stent coil embolization, and carotid stenting. After invasive and dual antiplatelet therapy, complete resolution of symptoms was achieved in all patients.

Internal Carotid Artery Dissection Treated with C-Guard Stent

“…A feared complication of the dissection is the formation of a pseudoaneurysm, coexisting in $13 to 49% of cases 6 these can experience enlargement in a minor percentage of cases (5%) and most of them remain stable. 7 Depending on the localization of the pseudoaneurysm, cranial nerve compromise can occur, being the hypoglossal nerve the most affected. 5 According to Guillon et al, $65% of the pseudoaneurysms that develop after an arterial dissection in the carotid artery remain stable, 30% decrease in size, and the rest disappear.…”

Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma

“…For instance, Kadkhodayan et al (2005) reported that 9 traumatic carotid dissections with/without associated pseudoaneurysms were effectively treated with CAS; in this report, some pseudoaneurysms were given coiling simultaneously [71]. Currently, there is no consensus on whether coiling is needed during CAS for pseudoaneurysms, but it is reasonable that large and wide-necked coiling should be recommended [74][75][76]. A typical case is shown in Figure 3.…”

“…Although intracranial stents can be used for this indication, they may not possess enough radial force to exclude false lumen or provide enough flow diversion to promote thrombosis of the pseudoaneurysm; because of their large cell design, they can rarely be used alone [74]. Therefore, the intracranial stent cannot be used routinely [86].…”