Symptomatic Post Endarterectomy Common Carotid Artery Pseudoaneurysm Treated with Combination of Flow Diverter Implantation and Carotid Stenting

Abstract

A 74-year-old male developed cervical carotid artery psuedoaneurysm 8 months after carotid endarterectomy. The patient was successfully managed with dual implantation of flow-diverter and conventional carotid stent. Flow-diverter was placed across the neck of pseudoaneurysm to provide flow diversion while carotid stent was implanted within the lumen of the expanded flow-diverter to approximate and hold the flow diverter proximal and distal to the pseudoaneurysm. Follow-up ultrasonography revealed complete resolution of the pseudoaneurysm.

Stent-assisted Coil Embolization to Treat Extracranial Carotid Artery Aneurysm 13 Years after Endarterectomy: A Case Report

“…15) Likewise, a Flow-Diverter stent could not be used because it is not available in the size that would have been needed for this case. 17) In previous reports, overlapping bare metal stents have had good short-term results, but no long-term results have been reported until now. 19) Therefore, we decided that it was necessary to use a coil combination.…”

“…Types of stents reported in the literature include covered stents, bare metal stents, and Flow-Diverter stents. [15][16][17] In situations where the vascular endothelium has failed, such as cases with dissection or a failed CEA, the endovascular approach with a metal stent is useful. 18) In this case, the continuity between the aneurysm and the common carotid artery was confirmed adventitia by MRI (Fig.…”

Surgical Treatment of Post-Carotid Endarterectomy Carotid Pseudoaneurysm

“…Carotid artery PEPA is a rare complication of CEA, reported to occur in about 0.3e0.6% of the procedures. 3 Although this complication can arise both after patch angioplasty and direct suture closure, some authors found it to be twice as common after patch angioplasty. 1 The factors that can lead to PEPA include suture line disruption, degeneration of the arterial wall or patch, infection, or even clamp/shunt induced damage.…”

“…1,2 Post-endarterectomy pseudoaneurysms (PEPA) are a rare complication of CEA that occur in about 0.3e0.6% of the procedures. 3 The aetiology includes suture line failure and degeneration of the arterial wall or of the patch. Additionally, some authors report this rare complication to be twice as common after patch angioplasty compared with primary closure.…”

“…Additionally, some authors report this rare complication to be twice as common after patch angioplasty compared with primary closure. 1,3,4 This video shows the surgical procedure in a case of PEPA 10 years after CEA with patch closure, which was successfully managed by surgical excision and interposition of great saphenous vein graft.…”