Successful Obliteration of a Pseudoaneurysm from Post-CEA Repair Secondary to a Pruitt-Inahara Shunt Using a Stent Graft

Abstract

Pseudoaneurysms of the carotid artery are very uncommon complications following carotid endarterectomy. Pseudoaneurysms are usually caused by any kind of blunt injury or trauma during carotid artery surgery. CEA has become an increasingly more common vascular surgery performed in the United States. The standard of treatment for a carotid PA has been open surgical repair with excision of the defect and then a graft reconstruction of the artery. Advancements in endovascular intervention have helped to make it a more popular choice in treatment because of the positive results and less invasive approach. This case report describes the successful obliteration of a large post-CEA PA using a stent graft. The PA was likely secondary to the use of a Pruitt-lnahara Shunt because it was found to be distal to the endarterectomized area of the carotid artery which means that the defect was likely caused by the balloon portion of the shunt. This case demonstrates the feasibility of using endovascular interventional techniques to treat a PA using a stent graft.

Adjunctive techniques in endovascular repair of postcarotid endarterectomy pseudoaneurysm: Case report and literature review

“…In the literature review process, we found 29 papers for an overall amount of 39 patients with post-CEA PA treated by an endovascular approach since 2000 (Table 1). Twenty were patients from isolated case reports, 4,5,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] the remaining were extracted from small case series dealing with extracranial carotid aneurysms regardless of the etiology. 3,8,[26][27][28][29][30][31][32] Overall mortality was 2.6% (1 for myocardial infarction), and neurological complications occurred in 5.1% (2 TIAs).…”

Successful Management with 2 Overlapping Bare Stents for Post–Carotid Endarterectomy Carotid Pseudoaneurysm Secondary to Carotid Shunt

“…2 PAs of the internal carotid artery distal to the surgically exposed zone are very rare; the main etiology in such cases has been attributed to Pruitt-Inahara shunt balloon inflation. 3,4 This device is commonly used during CEA to provide blood flow to the brain whenever intolerance to vessel clamping occurs. A balloon is inflated in both the common and the internal carotid artery to fix the device during endarterectomy.…”

“…3,4 In the first one, 3 the authors reported that, considering the small size of the PA which remained unchanged during follow-up, they decided against taking an invasive approach. They also suggested 3 explanations for PA formation after CEA: distal balloon overinflation, normal balloon inflation in a previously damaged area of the artery, and local dissection followed by PA formation.…”