Traumatic aneurysm of the supraclinoid internal carotid artery and an associated carotid—cavernous fistula: vascular reconstruction performed using intravascular implantation of stents and coils

Abstract

This report documents the treatment of a traumatic aneurysm of the supraclinoid internal carotid artery (ICA) that was associated with a carotid-cavernous fistula (CCF), which appeared following closed head trauma. This life-threatening lesion, which is very rare, required aggressive management achieved using intravascular stents and coils. A 19-year-old man presented with severe traumatic intracerebral and subarachnoid hematoma after he had suffered a severe closed head injury in a motor vehicle accident. Cerebral angiography performed 11 days after the injury demonstrated a traumatic aneurysm and severe narrowing of the right supraclinoid ICA, which was consistent with a dissection-induced stenosis associated with a direct CCF. Both lesions were successfully obliterated with preservation of the parent artery by using stents in conjunction with coils. Follow-up angiography obtained 7 months postoperatively revealed persistent obliteration of the aneurysm and CCF as well as patency of the parent artery. The patient remained asymptomatic during the clinical follow-up period of 14 months. Endovascular treatment involving the use of a stent combined with coils appears to be a feasible, minimally invasive option for treatment of this hard-to-treat lesion.

Treatment of Carotid Cavernous Fistulas Using Covered Stents: Midterm Results in Seven Patients

“…The angiogram demonstrated a rare type of direct CCF located above the level of the ophthalmic artery and the anterior clinoid process (Bouthillier segment C6). 27 Using the same technique previously described, we advanced a covered stent (3.5 ϫ 14 mm Jostent GraftMaster) above the level of the anterior clinoid process, where the fistula was identified. Special attention was paid not to occlude the anterior choroidal artery or the posterior communicating artery.…”

Embolization Using Endovascular Technique in Acute and Chronic Stages of Traumatic Ophthalmic Artery Aneurysm -Case Report-

“…11) Active and rapid treatment of such lesions is necessary because rupture usually occurs within 2-3 weeks after trauma. 3,10) In the present case, the fragile nature of the aneurysm wall was the main cause of regrowth of the aneurysm. The true aneurysm wall supporting the stable coil basket against the blood pressure may be absent in the acute stage of traumatic false aneurysm.…”

“…10) Moreover, neck clipping or trapping of both sides of the aneurysm may not be feasible because of the fragile nature and location of the aneurysm. 10) In the present case, endovascular treatment was preferred over conventional surgical procedures to guarantee the isolation of the aneurysm from the circulatory system. However, obliteration of an aneurysm with maintenance of the parent artery flow is not always appropriate and safe because the wall of the aneurysm may be formed by thickened arachnoid and surrounding cortex in the acute stage without development of a neck.…”

Traumatic Aneurysm of the Supraclinoid Internal Carotid Artery -Case Report-

“…Recently, several new treatments using stents have been described. 4,17) The long-term efficacy and safety of these treatments for supraclinoid traumatic aneurysms remain unclear, but these new modalities may be very useful in the near future, especially in the case of insufficient collaterals. …”