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Payman AA, Pecoraro NC, Tsiang JT, Souter J, Hand R, Bechara CF, Serrone JC. Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review. World Neurosurg 2024; 184:e603-e612. [PMID: 38336211 DOI: 10.1016/j.wneu.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases. METHODS The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration. RESULTS Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P = 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P = 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P = 0.001). CONCLUSIONS In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.
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Affiliation(s)
- Andre A Payman
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
| | - Nathan C Pecoraro
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John T Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John Souter
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert Hand
- Loyola University Medical Center, Maywood, Illinois, USA
| | - Carlos F Bechara
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Department of Neurological Surgery, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA
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Ma X, Zhang Y, Yang ZJ, Bo W, Wang XC, Zhang C, Liu PN, Bi ZY. Internal carotid artery injury during endoscopic transsphenoidal pituitary surgery: risk factors, management. Neurochirurgie 2024; 70:101515. [PMID: 38052154 DOI: 10.1016/j.neuchi.2023.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/25/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Transsphenoidal surgeons should try to avoid internal carotid artery (ICA) injury but also be prepared to manage it. We analyzed our experience with ICA injury during endoscopic transsphenoidal pituitary surgery and present associated risk factors and a management protocol. METHODS We retrospectively reviewed and analyzed the medical records of 1596 patients who underwent endoscopic transsphenoidal surgery for pituitary tumor resection in our institution from January 2009 to October 2022. RESULTS Six patients experienced an ICA injury. All received timely and effective hemostasis with immediate direct tamponade followed by endovascular treatment. No serious postoperative complications occurred. CONCLUSIONS We proposed a treatment plan for ICA injuries encountered during endoscopic transsphenoidal surgery and described our hemostasis process, methods of endovascular treatment, and means of postoperative follow-up in detail.
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Affiliation(s)
- Xin Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Yu Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Zhi-Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Wang Bo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Xin-Chao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pi-Nan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China.
| | - Zhi-Yong Bi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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3
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Ucaroglu ER, Tahtabasi M. Surgical Treatment of Extracranial Internal Carotid Artery Pseudoaneurysm in an Infant Due to Falling from Height: An Unusual Case. Int Med Case Rep J 2023; 16:667-672. [PMID: 37840971 PMCID: PMC10576563 DOI: 10.2147/imcrj.s433360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023] Open
Abstract
Pseudoaneurysms of the internal carotid artery (ICA) caused by non-penetrating trauma are extremely rare. Patients with ICA pseudoaneurysms may present with cerebral ischemia, cervical masses, neck swelling, hematoma, rupture, pain, or cranial nerve dysfunction. We present a case of a left ICA pseudoaneurysm that developed in a 7-month-old infant because of a fall from height. The patient developed left-sided neck swelling that caused severe airway obstruction and respiratory arrest. The patient was urgently intubated and underwent emergency surgery under general anesthesia to repair the defect in the left ICA. Primary repair was performed to treat the pseudoaneurysms. The pseudoaneurysm sac was not removed because it was complicated and had extended into the respiratory tract. The patient was extubated on the 2nd day and discharged on the 7th day without complications. Follow-up of the patient after two weeks was unremarkable. Extracranial ICA pseudoaneurysms should be identified in patients presenting with blunt trauma. Emergency surgery should be considered for patients with progressive pseudoaneurysms.
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Affiliation(s)
- Erhan Renan Ucaroglu
- Department of Cardiovascular Surgery, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Mehmet Tahtabasi
- Department of Radiology, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
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4
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Tanburoglu A, Andic C. Endovascular Treatment of Vascular Injuries in the Craniocervical Region With a Graft Stent: A Single-Center Experience. Cureus 2023; 15:e47323. [PMID: 37869052 PMCID: PMC10586528 DOI: 10.7759/cureus.47323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/24/2023] Open
Abstract
AIM We aimed to evaluate the efficacy and safety of graft stent implantation in the endovascular treatment of vascular injuries in the craniocervical area. MATERIALS AND METHODS This study was carried out through the retrospective screening of eight (two females and six males) patients' records. Patients who used graft stents as an endovascular method were included in the study. The mean age of the patients was 43.6 years (with a range of 15-69 years). Due to different mechanisms, the patients had vascular injuries in the craniocervical region, and graft stent implantation was performed between 2010 and 2022. We evaluated patient demographics, admission symptoms, trauma mechanisms, angiographic findings, treatment modalities and materials, patient outcomes, and follow-up periods. RESULTS Due to iatrogenesis for four patients, penetrating trauma for three patients, and blunt trauma for one patient, injuries were present in the right internal carotid artery {ICA} (n=1), left ICA (n=1), left common carotid artery {CCA} (n=3), right CCA (n=1), right vertebral artery (n=1), and left vertebral artery (n=1). Angiographically, pseudoaneurysm was detected in seven patients, and vascular rupture was detected in one patient using contrast agent extravasation. All patients who underwent the endovascular method had technical success. Since bleeding from the external carotid artery branches was seen in two patients, these branches were embolized with coils. No radiologically or neurologically pathological findings were recorded during the follow-up period (with a range of one week to 12 years). CONCLUSION Graft stent use in the endovascular treatment of craniocervical vascular injuries is an operable, safe, and promising option, especially in patients with pseudoaneurysms and active bleeding.
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Affiliation(s)
| | - Cagatay Andic
- Interventional Radiology, Faculty of Medicine, Baskent University, Adana, TUR
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5
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Housley SB, Turner RC, Bouslama M, Lim J, Raygor KP, Lai PMR, Monteiro A, Baig AA, Nyabuto E, Davies JM, Siddiqui AH, Snyder KV, Levy EI. Expansion and Subsequent Rupture of Carotid Pseudoaneurysm After Tandem Carotid and Middle Cerebral Artery Occlusion Treated With Mechanical Thrombectomy and Carotid Stenting. Oper Neurosurg (Hagerstown) 2023; 25:e206-e210. [PMID: 37387562 DOI: 10.1227/ons.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/03/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Extracranial carotid artery pseudoaneurysm is a rare entity with potential etiologies including infection, blunt trauma, postsurgical atherosclerotic disease, and invasive neoplasia. Although the natural history of carotid pseudoaneurysm is difficult to determine because of its rarity, complications such as stroke, rupture, and local mass effect may occur at staggering rates. CLINICAL PRESENTATION In this case, a middle-aged man presented with a tandem carotid, middle cerebral artery occlusion that was treated with a carotid stent and mechanical thrombectomy. He returned 3 weeks later with a ruptured carotid pseudoaneurysm that was then treated with a covered stent. He made a full recovery and was neurologically intact on follow-up. CONCLUSION This case illustrates a rare potential complication of carotid occlusion and stenting with possible catastrophic consequences. The goal of this report was to educate other clinicians in remaining vigilant in awareness of this complication and provide a framework for potential treatment if and when it occurs.
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Affiliation(s)
- Steven B Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ryan C Turner
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Mehdi Bouslama
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Elizabeth Nyabuto
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Murakami T, Toyota S, Takahara M, Touhara K, Hagioka T, Hoshikuma Y, Achiha T, Shimizu T, Kobayashi M, Kishima H. Overlapped Double-Layer Micromesh Stents for Giant Extracranial Internal Carotid Artery Aneurysm. J Neuroendovasc Ther 2023; 17:167-172. [PMID: 37609576 PMCID: PMC10442174 DOI: 10.5797/jnet.cr.2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/25/2023] [Indexed: 08/24/2023]
Abstract
Objective Extracranial internal carotid artery aneurysms (ECAAs) are rare. We herein describe a case of overlapped stenting with two double-layer micromesh stents for a giant ECAA. Case Presentation A 73-year-old man presented to our hospital with an enlarged right posterior cervical mass. A right internal carotid artery (ICA) angiogram revealed a giant aneurysm of 50 × 60 mm. We chose a carotid double-layer micromesh stent for stenting. With the patient under general anesthesia, the first double-layer micromesh stent (CASPER Rx, 10 × 30 mm; Terumo, Tokyo, Japan) was deployed between the ICA distal to the aneurysm and the common carotid artery (CCA). The second stent was also deployed from a site more proximal than the first one. Ten coils were then placed from a microcatheter that had been placed in the aneurysm. A right CCA angiogram after the procedure revealed a flow-diversion effect for the aneurysm. The patient was discharged with no complications. At the 6-month follow-up angiogram, blood flow into the aneurysm had completely disappeared. Conclusion A flow-diversion effect using overlapped double-layer micromesh stents can result in thrombosis and healing of giant ECAAs.
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Affiliation(s)
- Tomoaki Murakami
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Shingo Toyota
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Motohide Takahara
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Kazuhiro Touhara
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tatsuya Hagioka
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yuhei Hoshikuma
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takamune Achiha
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takeshi Shimizu
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Maki Kobayashi
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Tuan NHN, Van Khoa L, Van Tien Bao N, Tu PD, Van Phuoc L. Endovascular management of giant post-traumatic pseudoaneurysm in cavernous sinus: A case report. Radiol Case Rep 2023; 18:2514-2518. [PMID: 37214327 PMCID: PMC10199404 DOI: 10.1016/j.radcr.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
A 20-year-old male was admitted with the history of a traumatic head injury after traffic accident. The physical examination revealed blurred vision, swelling of the right face, and minor epistaxis. CT and MRI findings revealed a giant pseudoaneurysm of cavernous carotid artery. The patient was enrolled endovascular coils embolization of the internal carotid artery. After the procedure, the patient recovered well. Endovascular treatment is an effective therapy in cavernous carotid pseudoaneurysm.
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8
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Han JW, Lee JI, Hwangbo L. [Endovascular Treatment for Head and Neck Trauma]. J Korean Soc Radiol 2023; 84:792-808. [PMID: 37559799 PMCID: PMC10407061 DOI: 10.3348/jksr.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 08/11/2023]
Abstract
Trauma to the head and neck region can have serious consequences for vital organs such as the brain, and injuries to blood vessels can cause permanent neurological damage or even death. Thus, prompt treatment of head and neck vessels is crucial. Although the level of evidence is moderate, an increasing amount of research indicates that endovascular treatments can be a viable alternative to traditional surgery or medical management. Embolization or reconstructive endovascular procedures can significantly improve patient outcomes. This article provides an overview of various endovascular options available for specific clinical scenarios, along with examples of cases in which they were employed.
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Hong CK, Byun J, Park W, Kim YH, Park JC, Ahn JS, Kim JH. Management of Internal Carotid Artery Injury During Transsphenoidal Surgery: A Case Series and Suggestion for Optimal Management. World Neurosurg 2022; 163:e230-e237. [PMID: 35364296 DOI: 10.1016/j.wneu.2022.03.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Internal carotid artery (ICA) injury during transsphenoidal surgery is a rare but serious complication. We analyzed a series of ICA injuries that occurred during a transsphenoidal approach to suggest an optimal management strategy. METHODS Between January 2015 and May 2020, we enrolled 10 cases of ICA injury at our institution. RESULTS Among the 10 patients enrolled, 5 had pituitary adenoma, 2 had craniopharyngioma, and 1 each had skull base chondrosarcoma, tuberculum sellae meningioma, and nasopharyngeal cancer; 4 were revision surgery cases. The cavernous segment of the ICA was the most commonly injured area. The most common reason for ICA injury was a drill injury at the sellar floor opening. A direct repair was performed using a clip in only 1 patient. In the others, bleeding control of the injured ICA was achieved by packing multiple cotton pads. After angiography, 6 patients underwent immediate endovascular sacrifice of the injured ICA. In 3 patients who showed poor collateral flow from the anterior communicating and posterior communicating arteries, revascularization surgery was performed before endovascular trapping. After 6 postoperative months, 6 patients showed favorable functional outcomes, and 4 patients showed poor functional outcomes. CONCLUSIONS Prompt control of bleeding, endovascular management of injured ICA, and consideration of revascularization surgery based on collateral flow may prevent catastrophic neurological sequelae.
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Affiliation(s)
- Chang Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neuro-intervention, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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10
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Tas A, Bozan N, Akin R, Aycan A. Embolization after internal carotid artery injury secondary to transsphenoidal pituitary surgery and delayed intranasal coil protrusion: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE2215. [PMID: 35733820 PMCID: PMC9204935 DOI: 10.3171/case2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The authors presented a case of spontaneous nasopharyngeal coil migration that occurred 3 years after a patient had undergone transsphenoidal resection due to pituitary macroadenoma and was treated with coil application because of internal carotid artery injury secondary to transsphenoidal resection of the pituitary macroadenoma. OBSERVATIONS In the literature, eight cases of coil migration that occurred between 2 and 120 months after coil application have been reported, most of which were treated with surgical removal of the coil in a same-day surgery setting. LESSONS The case presented emphasized that coil protrusion and migration may lead to destruction in the skull base, thereby leading to serious consequences if left untreated, even in the absence of history of trauma. To the authors’ knowledge, this is the first case in the literature that required additional invasive procedures due to recurrent bleeding that occurred several months after surgical removal of coils. Also, this report underlined the need for careful and long-term follow-up of coil materials used for the treatment of pseudoaneurysms caused by vascular injuries secondary to skull base injury during surgery.
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Affiliation(s)
| | - Nazim Bozan
- Ear-Nose-Throat, Van Yuzuncu Yil University, Van, Turkey
| | - Ramazan Akin
- Ear-Nose-Throat, Van Yuzuncu Yil University, Van, Turkey
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11
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Li W, Liu Q, Wang H, Zhang H, Liu Q, Hu L, Li H, Dai J, Sun X, Yu H, Wang D. Innovative application of internal carotid artery embolization in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: A case-matched comparison. Int Forum Allergy Rhinol 2021; 12:838-848. [PMID: 34773719 DOI: 10.1002/alr.22927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/14/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The efficacy and safety of internal carotid artery (ICA) embolization as a treatment strategy in recurrent nasopharyngeal carcinoma (rNPC) patients with tumors invading the ICA remain unclear. METHODS We enrolled all rNPC patients with tumors invading the ICA, who underwent salvage endoscopic surgery. Using propensity scores to adjust for specific potential prognostic factors, a well-balanced cohort of 42 patients with limited rNPC was formed by matching each patient who underwent ICA embolization (study group) with one who did not (control group). The survival rates and common treatment-related complications were compared between the 2 groups. RESULTS The cohort included patients with the following tumor stages: rT2 (n = 3), rT3 (n = 24), and rT4 (n = 15). During a median follow-up of 15 (range, 2-63) months, the 2-year overall survival and progression-free survival rates were significantly higher in the ICA embolization group than in the ICA nonembolization group (90.5% vs 53.3% and 71.3% vs 33.0%, respectively; and p = 0.022 and p = 0.006, respectively). In addition, the incidence of treatment-related complications, such as nasal obstruction, nasopharyngeal hemorrhage, and nasopharyngeal necrosis, was significantly lower in the ICA embolization group than in the nonembolization group (p = 0.001, p = 0.014, and p = 0.038, respectively). CONCLUSION The innovative application of ICA embolization in endoscopic surgery in patients with rNPC invading the ICA significantly improved patient survival and reduced the risk of treatment-related complications. Therefore, this may be a safe and effective method with the potential to improve outcomes in rNPC patients.
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Affiliation(s)
- Wanpeng Li
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Qiang Liu
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Huangkang Zhang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Quan Liu
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Li Hu
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Houyong Li
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Jiong Dai
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xicai Sun
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
| | - Hongmeng Yu
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China.,Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor (2018RU003), Chinese Academy of Medical Sciences, Beijing, China
| | - Dehui Wang
- ENT Institute and Department of Otorhinolaryngology, Affiliated ENT Hospital, Fudan University, Shanghai, China
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Yang R, Wu H, Chen B, Sun W, Hu X, Wang T, Guo Y, Qiu Y, Dai J. Balloon Test Occlusion of Internal Carotid Artery in Recurrent Nasopharyngeal Carcinoma Before Endoscopic Nasopharyngectomy: A Single Center Experience. Front Oncol 2021; 11:674889. [PMID: 34295815 PMCID: PMC8290142 DOI: 10.3389/fonc.2021.674889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives Endoscopic nasopharyngectomy (ENPG) is a promising way in treating recurrent nasopharyngeal carcinoma (rNPC), but sometimes may require therapeutic internal carotid artery (ICA) occlusion beforehand. Balloon test occlusion (BTO) is performed to evaluate cerebral ischemic tolerance for ICA sacrifice. However, absence of neurological deficits during BTO does not preclude occur of delayed cerebral ischemia after permanent ICA occlusion. In this study, we evaluate the utility of near-infrared spectroscopy (NIRS) regional cerebral oxygen saturation (rSO2) monitoring during ICA BTO to quantify cerebral ischemic tolerance and to identify the valid cut-off values for safe carotid artery occlusion. This study also aims to find out angiographic findings of cerebral collateral circulation to predict ICA BTO results simultaneously. Material and Methods 87 BTO of ICA were performed from November 2018 to November 2020 at authors’ institution. 79 angiographies of collateral flow were performed in time during BTO and classified into several Subgroups and Types according to their anatomic and collateral flow configurations. 62 of 87 cases accepted monitoring of cerebral rSO2. Categorical variables were compared by using Fisher exact tests and Mann–Whitney U tests. Receiver operating characteristic curve analysis was used to determine the most suitable cut-off value. Results The most suitable cut-off △rSO2 value for detecting BTO-positive group obtained through ROC curve analysis was 5% (sensitivity: 100%, specificity: 86%). NIRS rSO2 monitoring wasn’t able to detect BTO false‐negative results (p = 0.310). The anterior Circle was functionally much more important than the posterior Circle among the primary collateral pathways. The presence of secondary collateral pathways was considered as a sign of deteriorated cerebral hemodynamic condition during ICA BTO. In Types 5 and 6, reverse blood flow to the ICA during BTO protected patients from delayed cerebral ischemia after therapeutic ICA occlusion (p = 0.0357). In Subgroup IV, absence of the posterior Circle was significantly associated with BTO-positive results (p = 0.0426). Conclusion Angiography of cerebral collateral circulation during ICA BTO is significantly correlated with ICA BTO results. Angiographic ICA BTO can be performed in conjunction with NIRS cerebral oximeter for its advantage of being noninvasive, real-time, cost-effective, simple for operation and most importantly for its correct prediction of most rSO2 outcomes of ICA sacrifice. However, in order to ensure a safe carotid artery occlusion, more quantitative adjunctive blood flow measurements are recommended when angiography of cerebral collateral circulation doesn’t fully support rSO2 outcome among clinically ICA BTO-negative cases.
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Affiliation(s)
- Renhao Yang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Wu
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Binghong Chen
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhua Sun
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Hu
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tianwei Wang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yubin Guo
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongming Qiu
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiong Dai
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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13
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Shi Y, Gao Y, Liu Y, Cui W, Zhou G, Wang L, Yu J, Zhang T, Qu Y, Deng J, Ge S. Treatment of Traumatic Intracranial Pseudoaneurysms: A Single-Center Experience. Front Neurol 2021; 12:690284. [PMID: 34248827 PMCID: PMC8267006 DOI: 10.3389/fneur.2021.690284] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: As a rare lesion secondary to brain trauma, traumatic intracranial aneurysms (TICAs) lead to high mortality and morbidity, and multiple treatment modalities have been applied for TICAs. All patients diagnosed with TICAs in our institution from 2010 to 2020 were included in the report, and their clinical features, treatment, and outcomes are described in detail. The purpose of this study is to illustrate the characteristic of different therapeutic methods of TICAs, and focus on the endovascular treatment. Methods: A total of 20 patients were included in this study. The 3 patients who declined treatment all died. Five of the other 17 patients were treated surgically, including clipping, wrapping, and trapping with or without EC-IC high-flow bypass, with only 1 case of parent artery preservation. Twelve patients underwent endovascular treatment, including bare coil embolization (1 case), stent-assisted coiling (2 cases), balloon-assisted coils/Onyx glue embolization (1 case) and covered stents (8 cases), with only 1 case of parent artery sacrifice. Results: 20 patients were included in the present study with 17 males, and the mean of age on 27 years (IQR: 22, 44 years). Eight patients presented with epistaxis, followed by 5 patients with coma, 3 patients with visual defects and 2 patients with CSF leakage. There were 18 TICAs located at the internal carotid artery (ICA); The other 2 TICAs located at pericallosal artery and A1 segment anterior cerebral artery (ACA). One case of diplopia occurred due to sacrifice of the ICA. Occlusion of the ophthalmic artery occurred in 3 patients after placement of a covered stent, with 1 patient suffering an irreversible vision decrease. None of the other patients who underwent the treatment have experienced an aggravation of their symptoms since the treatment; During the imaging follow-up, 1 case of recurrence and 1 case of endoleak occurred in this case series. Conclusions: TICAs are associated with significant morbidity and mortality, and endovascular treatment has emerged as a valuable option, which may be promising to improve the clinical outcomes due to their advantages of preserving the parent artery if occlusion of the side branch artery can be avoided.
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Affiliation(s)
- Yingwu Shi
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuan Gao
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Yufei Liu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wenxing Cui
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Gaoyang Zhou
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jia Yu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tao Zhang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianping Deng
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Shunnan Ge
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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14
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Jariwala P, Punjani A, Kamble R. Endovascular management of the post-traumatic common carotid artery pseudoaneurysms. Pol J Radiol 2021; 86:e287-90. [PMID: 34136046 DOI: 10.5114/pjr.2021.106223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Pseudoaneurysms of the common carotid artery secondary to high-velocity fragment injuries to the head and neck in patients are uncommon lesions. Multi-detector computed tomography angiography should be performed on all patients suffering from high-speed fragment injuries of the head and neck. Case presentation We share our experience with the endovascular management approach for the closure of 2 separate pseudoaneurysms involving the left common carotid artery. Conclusions Numerous options for surgical and endovascular treatment of these lesions are available. Endovascular therapy in patients with common carotid artery pseudoaneurysms offers a reliable and non-invasive management option. It helps in the mitigation of its rupture and thromboembolic complications.
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15
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Abstract
Cervical carotid and vertebral artery traumatic injuries can have a devastating natural history. This article reviews the epidemiology, mechanisms of injury, clinical presentation, and classification systems pertinent to consideration of endovascular treatment. The growing role of modern endovascular techniques for the treatment of these diseases is presented to equip endovascular surgeons with a framework for critically assessing patients presenting with traumatic cervical cerebrovascular injury.
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Affiliation(s)
- Ananth K Vellimana
- Department of Neurological Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jayson Lavie
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Arindam Rano Chatterjee
- Department of Neurological Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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16
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Wang G, Li C, Piao J, Xu B, Yu J. Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma. Int J Med Sci 2021; 18:944-952. [PMID: 33456352 PMCID: PMC7807178 DOI: 10.7150/ijms.50275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/18/2020] [Indexed: 11/15/2022] Open
Abstract
The extracranial internal carotid artery (ICA) refers to the anatomic location that reaches from the common carotid artery proximally to the skull base distally. The extracranial ICA belongs to the C1 segment of the Bouthillier classification and is at considerable risk for injury. Currently, the understanding of endovascular treatment (EVT) for blunt injury of the extracranial ICA is limited, and a comprehensive review is therefore important. In this review, we found that extracranial ICA blunt injury should be identified in patients presenting after blunt trauma, including classical dissection, pseudoaneurysm, and stenosis/occlusion. Computed tomography angiography (CTA) is the first-line method for screening for extracranial ICA blunt injury, although digital subtraction angiography (DSA) remains the "gold standard" in imaging. Antithrombotic treatment is effective for stroke prevention. However, routine EVT in the form of stenting should be reserved for patients with prolonged neurological symptoms from arterial stenosis or considerably enlarged pseudoaneurysm. Endovascular repair is now emerging as a favored therapeutic option given its demonstrated safety and positive clinical and radiographic outcomes.
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Affiliation(s)
- Guangming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Chao Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jianmin Piao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
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17
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Wang W, Liang X, Chen G, Yang P, Zhang J, Liu H, Zhao S, Li Y, Sun B, Kang J. Treatment of Intracranial Pseudoaneurysms With a Novel Covered Stent: A Series of 19 Patients With Midterm Follow-Up. Front Neurol 2020; 11:580877. [PMID: 33324325 PMCID: PMC7723868 DOI: 10.3389/fneur.2020.580877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/21/2020] [Indexed: 01/04/2023] Open
Abstract
Background: The optimal treatment for intracranial pseudoaneurysm is unclear. This study aims to analyze the outcome of treating intracranial pseudoaneurysm with a novel covered stent. Materials and Methods: The institutional imaging and clinical databases were retrospectively reviewed for patients with intracranial pseudoaneurysms treated with Willis covered stent from January 2017 to December 2019. The clinical presentations, etiology, intraoperative complications, and immediate and follow-up outcomes were analyzed. Results: A total of 19 patients with 20 pseudoaneurysms were enrolled for analysis. Seventeen patients presented with vision loss and two with epistaxis. Nineteen Willis covered stents were used with one for each patient without technical failure. Intraoperative thrombosis was encountered in one patient (5.3%), which was recanalized by tirofiban. During clinical follow-up, no further epistaxis occurred, and visual acuity improved in three (17.6%) patients. Endoleak occurred in seven (36.8%) patients after the initial balloon inflation and persisted in one (5.3%) patient after balloon re-inflation. This endoleak disappeared at 8 month follow-up. Finally, during angiographic follow-up (median 13 months), parent artery occlusion and in-stent stenosis occurred in one (5.3%) patient. No stent-related ischemic event was encountered. Conclusions: The Willis covered stent is feasible, safe, and efficient in treating intracranial pseudoaneurysms.
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Affiliation(s)
- Wei Wang
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Xihong Liang
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Guangli Chen
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Peng Yang
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Jialiang Zhang
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Haocheng Liu
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Shangfeng Zhao
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Yong Li
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Bowen Sun
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
| | - Jun Kang
- Neurosurgery Department, Tongren Hospital of Capital Medical University, Beijing, China
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18
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Ghorbani M, Griessenauer CJ, Shojaei H, Wipplinger C, Hejazian E. Endovascular reconstruction of iatrogenic internal carotid artery injury following endonasal surgery: a systematic review. Neurosurg Rev 2020; 44:1797-1804. [PMID: 32860104 DOI: 10.1007/s10143-020-01379-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/30/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
The objective of this study is to provide an update on endovascular treatments for iatrogenic internal carotid artery (ICA) injuries following endonasal surgery. A systematic review of the literature was performed by using Medline, Cochrane library, and Scopus from 1999 to 2019. We used a combination of the MeSH terms "internal carotid artery," "iatrogenic disease," and "endovascular procedure." Twenty-six articles including 46 patients were identified for in this systematic review. The mean age of the patients was 49 years (CI: ± 4.2). The most common site of ICA injury was in cavernous segment (18 patients; 39%). The most common type of iatrogenic ICA injury was a traumatic pseudoaneurysm documented in 28 patients (60%). Endoluminal reconstruction was performed using covered stents in 28 patients, the Pipeline embolization device (PED) in 13 patients, the Surpass flow diverter device in three, the SILK flow diverter in one, and one case was treated using a combined approach of a covered stent and a PED. Flow diversion and covered stents resulted in a good clinical outcome in 94% and 89% of patients, respectively. This difference did not reach statistical significance (p = 1.0). Even though this systematic review was limited due to articles of small sample sizes and considerable heterogeneity, the results indicate that flow diverting devices and covered stents are good therapeutic options for endoluminal reconstruction of iatrogenic ICA injuries following endonasal surgery.
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamidreza Shojaei
- Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
| | | | - Ebrahim Hejazian
- Department of Neurosurgery, Babol University of Medical Sciences, Babol, Mazandaran, Iran
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19
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Montorfano L, Sarkissyan M, Wolfers M, Rodríguez F, Pla F, Montorfano M. POCUS and POCDUS: essential tools for the evaluation and management of carotid artery pseudoaneurysms after a gunshot wound. Ultrasound J 2020; 12:35. [PMID: 32696140 PMCID: PMC7374642 DOI: 10.1186/s13089-020-00182-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Evaluation of asymptomatic penetrating vascular injuries can be done with Point-of-care ultrasound (POCUS) and Point-of-care Doppler ultrasound (POCDUS). CASE PRESENTATION A 21-year-old woman was admitted to the Emergency Department with a small wound and pain on the left side of her neck. The patient stated she was standing outside her home and suddenly felt acute pain in the neck. She denied trauma or being assaulted and reported no significant past medical or surgical history. On physical exam the only positive finding was a small gunshot entry wound on the left side of her neck without hard signs of vascular injury. Bedside POCUS demonstrated soft tissue swelling and a hematoma next to the left carotid artery. A round in shape bullet was visualized in contact with the posterior left common carotid artery wall and two small saccular pseudoaneurysms were seen at left common carotid artery wall. POCDUS showed a patent left carotid artery and turbulent flow in the two saccular aneurysms. A computed tomography angiogram (CTA) was performed confirming the findings and a stent in left carotid artery was placed. The patient tolerated the procedure well and was discharged 4 days after the procedure. At the sixth month follow-up, Doppler ultrasound showed patent stent and resolution of the muscular hematoma. CONCLUSIONS Penetrating trauma-related vascular injuries are complex cases to handle within an acute setting. POCUS and POCDUS are increasingly being used for the workup and decision-making process of gunshot-related vascular injuries to the neck and are a fundamental part of the follow-up after definitive therapy.
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Affiliation(s)
| | - Marianna Sarkissyan
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina
| | - Matthew Wolfers
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Federico Rodríguez
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina
| | - Fernando Pla
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina
| | - Miguel Montorfano
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina.
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20
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Wang K, Peng XX, Liu AF, Zhang YY, Lv J, Xiang L, Liu YE, Jiang WJ. Covered Stenting Is an Effective Option for Traumatic Carotid Pseudoaneurysm with Promising Long-Term Outcome. J Korean Neurosurg Soc 2020; 63:590-597. [PMID: 32272508 PMCID: PMC7477158 DOI: 10.3340/jkns.2019.0202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/14/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Covered stenting is an optional strategy for traumatic carotid pseudoaneurysm, especially in malignant conditions of potential rupture, but the long-term outcomes are not clear. Our aim was to determine if covered stenting is an effective option for traumatic carotid pseudoaneurysm with promising long-term outcomes.
Methods Self-expanding Viabahn and balloon-expandable Willis covered stents were separately implanted for extra- and intracranial traumatic carotid pseudoaneurysm. The covered stent was placed across the distal and proximal pseudoaneurysm leakage under roadmap guidance. Procedural success was defined as technical success (complete exclusion of the pseudoaneurysm and patency of the parent artery) without a primary end point (any stroke or death within 30 days after the procedure). Long-term outcomes were evaluated as ischemic stroke in the territory of the qualifying artery by clinical follow-up through outpatient or telephone consultation and as the exclusion of the pseudoaneurysm and patency of the parent artery by imaging follow-up through angiography.
Results Five patients with traumatic carotid pseudoaneurysm who underwent covered stenting were enrolled. The procedural success rate was 100%. No ischemic stroke in the territory of the qualifying artery was recorded in any of the five patients during a mean clinical follow-up of 44±16 months. Complete exclusion of the pseudoaneurysm and patency of the parent artery were maintained in all five patients during a mean imaging follow-up of 39±16 months.
Conclusion Satisfactory procedural and long-term outcomes were obtained, suggesting that covered stenting is an effective option for traumatic carotid pseudoaneurysm.
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Affiliation(s)
- Kai Wang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Xiao-Xin Peng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Ying-Ying Zhang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Jin Lv
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Li Xiang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yun-E Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Wei-Jian Jiang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
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21
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Elsisy M, Tillman BW, Go C, Kuhn J, Cho SK, Clark WW, Park J, Chun Y. Comprehensive assessment of mechanical behavior of an extremely long stent graft to control hemorrhage in torso. J Biomed Mater Res B Appl Biomater 2020; 108:2192-2203. [PMID: 31943806 DOI: 10.1002/jbm.b.34557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/16/2019] [Accepted: 01/06/2020] [Indexed: 11/07/2022]
Abstract
Traumatic vascular injuries, resulting from either civilian accidents or wounded soldiers, require new endovascular devices (i.e., stent graft) to rapidly control the excessive internal hemorrhage in torso region. Current stent designs are limited by their permanent nature, which is note well suited for emergent placement. A retrievable stent graft could regulate the internal bleeding temporarily, as fast as possible with the most feasible performance, until the patients arrive the hospital to receive the proper treatment. The novel endovascular device of this study is designed according to the anatomy of a porcine model with plans to transition to a human model in the future. The stent graft is manufactured using a substantially long nitinol backbone and covered selectively based on anatomic measurements, with highly stretchable expanded-polytetrafluoroethylene (ePTFE). In this study, our group comprehensively explored designing and manufacturing methods, and their impact on the stent graft performance. Geometric parameters and heat treatment conditions were investigated to show their effect on the radial force of the metallic backbone. As a retrievable device, the resistance force for retrieval as well as deployment were measured, and analyzed to be manipulated through ePTFE covering configurations. In vitro measurements for bleeding were measured using swine aorta to show the functionality of the stent graft under the simulated pulsatile flow circulation. Finally, the stent graft showed substantial effectiveness for hemorrhage control in vivo, using swine model. The new design and fabrication methods enable rapid hemorrhage control that can be removed at the time of a dedicated surgical repair.
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Affiliation(s)
- Moataz Elsisy
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan W Tillman
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Catherine Go
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jenna Kuhn
- McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sung K Cho
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William W Clark
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Junkyu Park
- Research and Development of Interventional Medicine, CGBIO, Jangseong, Republic of Korea
| | - Youngjae Chun
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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22
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Giannopoulos S, Trinidad E, Aronow H, Soukas P, Armstrong EJ. Εndovascular Repair of Extracranial Carotid Artery Aneurysms: A Systematic Review. Vasc Endovascular Surg 2020; 54:254-263. [PMID: 31894734 DOI: 10.1177/1538574419895383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Both true and false extracranial carotid artery aneurysms (ECAA) are a potential source of morbidity and mortality. While ECAA have historically been treated surgically, endovascular reconstruction with stenting is an emerging treatment option. The aim of our study was to report clinical/radiologic outcomes following endovascular repair of ECAAs. METHODS A comprehensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS A total of 68 case reports and case series, comprising 162 patients, were included. Most patients presented with at least one symptom or sign related to the ECAA (89.5%; N = 145/162). In 42.6% (N = 69/162) and 46.3% (N = 75/162) of the cases polytetrafluoroethylene covered and uncovered stents were deployed respectively. Immediate post-procedural imaging demonstrated complete aneurysm exclusion in 86.4% (N = 140/162) of the cases and minimal filling of the aneurysm sack in 10.5% (N = 17/162) of all cases. Perioperative adverse event rates were 3.1% for stroke, 1.2% for transient ischemic attack (TIA) and 4.3% for mortality. During a mean follow-up of 21.8months, there were additionally observed one stroke, two TIAs and three deaths. Overall 88.6 % of the patients (N = 117/132) remained asymptomatic, partially recovered or at least did not suffer from new neurologic deficits during follow up, with no signs of stenosis or occlusion of the carotid artery. CONCLUSIONS Endovascular stenting for the treatment of ECAAs is feasible with acceptable short- and long-term clinical and radiologic outcomes. Prospective real-world studies are needed to further validate the safety and the long-term patency of endovascular repair.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Evan Trinidad
- Department of Internal Medicine, UCHealth University of Colorado Hospital, Denver, CO, USA
| | - Herbert Aronow
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Peter Soukas
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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Nariai Y, Kawamura Y, Takigawa T, Hyodo A, Suzuki K. Pipeline embolization for an iatrogenic intracranial internal carotid artery pseudoaneurysm after transsphenoidal pituitary tumor surgery: Case report and review of the literature. Interv Neuroradiol 2019; 26:74-82. [PMID: 31505983 DOI: 10.1177/1591019919874943] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Intracranial pseudoaneurysms are uncommon and among the most difficult lesions to treat with surgery or endovascular means without parent artery sacrifice. Here, we report on a patient who underwent successful treatment using a flow-diverting stent for an iatrogenic intracranial internal carotid artery pseudoaneurysm following a vessel injury after endoscopic pituitary tumor resection via the transsphenoidal approach. A 62-year-old man with a Rathke's cleft cyst presenting with bitemporal hemianopia and progressive decline of left visual acuity underwent endoscopic transsphenoidal pituitary tumor resection. During dura incision, brisk arterial bleeding was encountered from the right internal carotid artery. Immediate packing was performed, and hemostasis was achieved. Three days after the vessel injury, an angiography revealed a pseudoaneurysm (2.9 × 2.1 mm) at the cavernous segment of the right internal carotid artery, which showed enlargement on follow-up magnetic resonance imaging at six days postoperatively. Pipeline embolization was performed nine days after the vessel injury. Angiography performed one month after Pipeline embolization revealed significant stagnation but not complete occlusion of blood flow inside the pseudoaneurysm cavity. Dual antiplatelet therapy was replaced with single antiplatelet therapy. Follow-up angiograms three months after Pipeline embolization confirmed complete obliteration of the pseudoaneurysm and successful endoluminal reconstruction of the damaged vessel. Despite the possibility of short-term bleeding and the need for dual antiplatelet therapy administration for a certain period, the use of flow-diverting stents is a feasible vessel-sparing option in the management of intracranial internal carotid artery pseudoaneurysms resulting from transsphenoidal surgery injuries if intraoperative hemodynamic stability can be achieved with effective packing.
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Affiliation(s)
- Yasuhiko Nariai
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yosuke Kawamura
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Liu L, Xie X. Letter to the Editor Regarding “Delayed Pipeline Embolization of a Ruptured True Internal Carotid Artery Aneurysm Presenting with Epistaxis—Case Report and Review of the Literature”. World Neurosurg 2019; 128:630. [DOI: 10.1016/j.wneu.2019.03.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/22/2022]
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Chen SH, McCarthy DJ, Sheinberg D, Hanel R, Sur S, Jabbour P, Atallah E, Chalouhi N, Dumont A, Amenta P, Hasan D, Raper D, Liu K, Jane JA, Crowley RW, Aguilar-Salinas P, Bentley J, Monteith S, Mitchell BD, Yavagal DR, Peterson EC, Starke RM. Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms. World Neurosurg 2019; 127:e86-e93. [PMID: 30849553 DOI: 10.1016/j.wneu.2019.02.135] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intracranial pseudoaneurysms (PSAs) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in using flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery. The objective of this study is to examine the safety and efficacy of these devices in the treatment of intracranial PSA. METHODS We performed a multi-institutional retrospective study of intracranial PSAs treated with the Pipeline Embolization Device (PED) between 2014 and 2017 at 7 institutions. Complications and clinical and radiographic outcomes were reviewed. RESULTS A total of 19 patients underwent PED placement for intracranial PSA. Iatrogenic injury and trauma comprised most etiologies in our series. The mean pseudoaneurysm diameter was 8.8 mm, and 18 of 19 PSAs (95%) involved the internal carotid artery (ICA). Multiple PEDs were deployed in a telescoping fashion in 7 patients (37%). Of the 18 patients with follow up imaging, 14 (78%) achieved complete pseudoaneurysm obliteration and 2 achieved near-complete obliteration (11%). Two patients (11%) were found to have significant pseudoaneurysm progression on short-term follow-up and required ICA sacrifice. No patients experienced new neurologic deficits or deterioration secondary to PED placement. No patients experienced bleeding or rebleeding from PSA. CONCLUSIONS In well-selected patients, the use of flow-diverting stents may be a feasible alternative to parent vessel sacrifice. Given the high morbidity and mortality associated with PSA, we recommend short- and long-term radiographic follow-up for patients treated with flow-diverting stents.
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Affiliation(s)
- Stephanie H Chen
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - David J McCarthy
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
| | - Dallas Sheinberg
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Ricardo Hanel
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA; Department of Neurological Surgery, Baptist Health, Miami, Florida, USA
| | - Samir Sur
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Elias Atallah
- Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aaron Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Peter Amenta
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - David Hasan
- Department of Neurological Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Daniel Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kenneth Liu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - John A Jane
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - R Webster Crowley
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Josh Bentley
- Department of Neurological Surgery, Swedish Health, Seattle, Washington, USA
| | - Stephen Monteith
- Department of Neurological Surgery, Swedish Health, Seattle, Washington, USA
| | - Bartley D Mitchell
- Department of Neurological Surgery, Methodist Institute, Houston, Texas, USA
| | - Dileep R Yavagal
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Eric C Peterson
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Siani A, Castrucci T, Accrocca F, Ianni G, Corona S, De Vivo G, Smedile G, Bartoli S. Endovascular Treatment with Two Overlapping Micromesh-Covered Stents and Balloon Guide Catheter for Symptomatic Carotid Pseudoaneurysm Ten Years after Eversion Endarterectomy. Ann Vasc Surg 2019; 58:379.e9-379.e13. [DOI: 10.1016/j.avsg.2018.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 11/23/2022]
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Lu WL, Wang B, Wu F, Wang MY, Pan JX, Xu H. Covered Stent–Assisted Open Surgery in the Treatment of an Extracranial Carotid Artery Pseudoaneurysm. Ann Vasc Surg 2019; 57:238-243. [DOI: 10.1016/j.avsg.2018.08.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/11/2018] [Accepted: 08/08/2018] [Indexed: 12/18/2022]
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Choi HC, Park SE, Choi DS, Shin HS, Kim JE, Choi HY, Park MJ, Koh EH. Ruptured extracranial carotid artery: Endovascular treatment with covered stent graft. J Neuroradiol 2018; 45:217-223. [DOI: 10.1016/j.neurad.2018.01.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 12/22/2017] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
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Palermo C, Sanfiorenzo A, Giaquinta AT, Virgilo C, Veroux M, Veroux P. Mini-invasive treatment of a large pseudoaneurysm of the neck related to central venous catheter placement: A case report. Medicine (Baltimore) 2018; 97:e11262. [PMID: 30024504 PMCID: PMC6086494 DOI: 10.1097/md.0000000000011262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Central venous catheter (CVC) placement, particularly in emergency setting, may be associated with significant morbidity and mortality. PATIENT CONCERNS A 33-year old woman with suspected pulmonary embolism, developed a pseudoaneurysm of the neck three days after a CVC placement in the right internal jugular vein, determining compression to adjacent neck structures. DIAGNOSES Computed tomography angiography and selective angiography demonstrated the presence of the pseudoaneurysm originating from the thyro-cervical trunk. INTERVENTIONS The treatment was minimally invasive with endovascular exclusion first, and an open thrombectomy to resolve compressive syndrome two days later. OUTCOMES The color Doppler ultrasound confirmed the complete exclusion of the pseudoaneurysm with patency of the thyroid artery. A comprehensive review of literature on the risk factors and management of the unintended artery puncture was included. LESSONS A correct technique under ultrasound guidance may reduce the incidence of unintended arterial injury during CVC placement. In patients with suitable anatomy and unfit for open repair, a minimally invasive approach provides a safe alternative to open surgery with excellent results.
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Agyei JO, Alvarez C, Iqbal A, Fanous AA, Siddiqui AH. Successful Kissing Balloon Expandable Stent Graft Treatment for a Right Common Carotid Pseudoaneurysm Caused by Tracheotomy. World Neurosurg 2018; 114:241-244. [PMID: 29602007 DOI: 10.1016/j.wneu.2018.03.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND A rare complication following tracheotomy is common carotid artery (CCA) pseudoaneurysm. Treatment modalities for CCA pseudoaneurysm include surgical repair and single-artery balloon-covered stent graft technique. We describe successful treatment of tracheotomy-related CCA pseudoaneurysm with the "kissing balloon" expandable stent graft technique. CASE DESCRIPTION We successfully implemented the kissing balloon expandable stent graft technique for treatment of a large, narrow-necked, bilobed CCA pseudoaneurysm that arose owing to a tracheotomy complication. The pseudoaneurysm was detected while performing a diagnostic angiogram of the aortic arch and surrounding vessels. The stent was deployed while the 2 balloons were introduced in a kissing manner such that they faced one another to avoid occlusion of either branch of the innominate artery coming into contact; 1 balloon was inflated at the origin of the right subclavian artery, and the other was inflated at the right innominate artery simultaneously. The pseudoaneurysm was successfully contained; normal blood flow was restored in the CCA. The balloons were deflated and withdrawn. The patient remained neurologically intact after the procedure. CONCLUSIONS The kissing balloon technique is a safe and effective alternative to surgical repair, as it prevents morbidities associated with the surgical procedure. Also, this technique decreases the risk of major side-branch occlusion associated with the single-artery balloon-covered stent graft technique.
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Affiliation(s)
- Justice O Agyei
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cynthia Alvarez
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
| | - Azher Iqbal
- Department of Vascular and Interventional Radiology, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, USA
| | - Andrew A Fanous
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Vascular and Interventional Radiology, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center at the University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
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Abstract
Endovascular treatment is a standard mode of treatment for traumatic cavernous internal carotid artery (ICA) pseudoaneurysms with good results and relatively low rates of complications. We describe a case of an unusual, potentially fatal, delayed postoperative event happening in a case of post-traumatic pseudoaneurysm of ICA, which had been previously managed with endovascular coiling.
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Affiliation(s)
- Anup Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nishchint Jain
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Leve Joseph Devarajan
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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Jiang Z, Yang J, Wang X. Endovascular coil embolization and stenting for the treatment of iatrogenic right internal mammary artery injury: A case report. J Int Med Res 2018; 46:1271-1276. [PMID: 29322817 PMCID: PMC5972256 DOI: 10.1177/0300060517740307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 54-year-old Chinese woman presented with a 10-year history of repeated paroxysmal palpitations. She was diagnosed with paroxysmal supraventricular tachycardia by 12-lead electrocardiogram and was advised to undergo catheter-based radiofrequency ablation. During the procedure, a rare complication occurred that was diagnosed as a right internal mammary artery penetrating injury. After appropriate emergency treatment with arterial embolization and membrane-covered stent implantation, the patient was out of immediate danger of haemorrhaging. Follow-up computed tomography angiography of the subclavian artery at 3 months after she was discharged from hospital revealed stent-graft patency with no evidence of in-stent thrombosis or stent stenosis. No problems were observed at the 6-month follow-up visit.
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Affiliation(s)
- Zhen Jiang
- 1 Department of Cardiology, First Affiliated Hospital, 26441 School of Medicine, Zhejiang University , Hangzhou, Zhejiang Province, China
| | - JinXiu Yang
- 2 Department of Cardiology, First Affiliated Hospital, 70571 Zhejiang Chinese Medicine University , Hangzhou, Zhejiang Province, China
| | - XingXiang Wang
- 1 Department of Cardiology, First Affiliated Hospital, 26441 School of Medicine, Zhejiang University , Hangzhou, Zhejiang Province, China
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Lucas O, Naseem HUR, Davies JM, Reynold R, Bass KD. Endovascular treatment of a carotid artery pseudoaneurysm due to penetrating trauma in a pediatric patient. Journal of Pediatric Surgery Case Reports 2017. [DOI: 10.1016/j.epsc.2016.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Alonso-Argüeso G, Rodriguez-Morata A, Vera-Arroyo B, Lara-Villoslada MJ, Gomez-Medialdea R. Endovascular Treatment of Complex Carotid-Jugular Fistula. Vasc Endovascular Surg 2016; 50:566-570. [PMID: 27852880 DOI: 10.1177/1538574416675675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Inadvertent complications of jugular vein catheterization are not uncommon, however, a persistent symptomatic carotid-jugular fistula has been rarely reported. A 72-year-old male with infected surgical wound after coxofemoral disarticulation for sarcoma presented with symptoms of acute right heart failure. A fistula between the right common carotid artery (CCA) and the internal jugular vein was demonstrated on Doppler ultrasound and confirmed on computed tomography angiogram. Catheterization of the right CCA seemed not possible using a conventional femoral approach due to the tortuosity and elongation of the brachiocephalic artery. A small incision in the right temporal area was used to access the superficial temporal artery and a wire was advanced retrograde into the aorta where it was snared from below, allowing for successful treatment of the fistula with a covered stent. This alternative technique may facilitate safe and stable carotid artery stenting even in patients with a severely tortuous access route due to atherosclerotic disease.
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Affiliation(s)
- Gonzalo Alonso-Argüeso
- 1 Department of Angiology and Vascular Surgery, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Alejandro Rodriguez-Morata
- 1 Department of Angiology and Vascular Surgery, Virgen de la Victoria University Hospital, Málaga, Spain
| | - Blanca Vera-Arroyo
- 1 Department of Angiology and Vascular Surgery, Virgen de la Victoria University Hospital, Málaga, Spain
| | | | - Rafael Gomez-Medialdea
- 1 Department of Angiology and Vascular Surgery, Virgen de la Victoria University Hospital, Málaga, Spain
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Katsevman GA, Braca JA, Welch KC, Ashley WW. Delayed Presentation of an Extracranial Internal Carotid Artery Pseudoaneurysm and Massive Epistaxis Secondary to a Nasal Foreign Body: Case Report and Review of the Literature. World Neurosurg 2016; 92:585.e13-585.e19. [DOI: 10.1016/j.wneu.2016.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 01/04/2023]
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37
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AlQahtani A, Castelnuovo P, Nicolai P, Prevedello DM, Locatelli D, Carrau RL. Injury of the Internal Carotid Artery During Endoscopic Skull Base Surgery. Otolaryngol Clin North Am 2016; 49:237-52. [DOI: 10.1016/j.otc.2015.09.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The role of nanotechnology enabled techniques in the evolution of vascular stents.
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Affiliation(s)
- Purandhi Roopmani
- Centre for Nanotechnology and Advanced Biomaterials (CeNTAB)
- School of Chemical and Biotechnology
- SASTRA University
- Thanjavur-613 401
- India
| | - Swaminathan Sethuraman
- Centre for Nanotechnology and Advanced Biomaterials (CeNTAB)
- School of Chemical and Biotechnology
- SASTRA University
- Thanjavur-613 401
- India
| | - Santhosh Satheesh
- Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER)
- Department of Cardiology
- Pondicherry-605 006
- India
| | - Uma Maheswari Krishnan
- Centre for Nanotechnology and Advanced Biomaterials (CeNTAB)
- School of Chemical and Biotechnology
- SASTRA University
- Thanjavur-613 401
- India
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Chen PR, Edwards NJ, Sanzgiri A, Day AL. Efficacy of a Self-Expandable Porous Stent as the Sole Curative Treatment for Extracranial Carotid Pseudoaneurysms. World Neurosurg 2015; 88:333-341. [PMID: 26724612 DOI: 10.1016/j.wneu.2015.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Extracranial carotid pseudoaneurysms are uncommon vascular lesions. Even with conservative management complications can happen, such as delayed cerebral embolization or symptoms due to flow limitation. Although endovascular therapy can be curative, literature demonstrating a preferred technique is scant. Our goal was to evaluate the use of 1 technique only-the deployment of overlapping self-expandable porous stents-to treat a series of extracranial carotid pseudoaneurysms. METHODS From 2008 to 2014, 14 consecutive cases of symptomatic extracranial carotid pseudoaneurysms were managed with single or multilayer porous stents at our institution. Each patient underwent a standardized angiographic follow-up at 6 months. Twelve patients also received a follow-up computed tomography angiogram at 12 months, and yearly thereafter (median radiographic follow-up, 38 months). The total clinical follow-up period ranged between 6 and 69 months (median, 46 months). RESULTS In our series, each of the extracranial carotid pseudoaneurysms appeared to be the result of carotid artery dissection with associated carotid stenosis at the origin of every pseudoaneurysm. Endovascular treatment consisted of 1-3 layers of self-expandable porous stents placed without balloon angioplasty. Immediately after stenting angiographic images were notable for stagnant opacification of the pseudoaneurysm through the stent(s). All pseudoaneurysms were completely obliterated by the 6-month follow-up angiogram and remained so throughout the radiographic follow-up period. Complications were minimal, consisting of 1 patient developing a mild Horner's syndrome after treatment that resolved during clinical follow-up. CONCLUSIONS Extracranial carotid pseudoaneurysms can be successfully obliterated with the use of porous, self-expandable stents.
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Affiliation(s)
- Peng Roc Chen
- Department of Neurosurgery, University of Texas Medical School at Houston, Houston, Texas, USA.
| | - Nancy J Edwards
- Department of Neurosurgery, University of Texas Medical School at Houston, Houston, Texas, USA; Department of Neurology, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Aditya Sanzgiri
- Department of Neurosurgery, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Arthur L Day
- Department of Neurosurgery, University of Texas Medical School at Houston, Houston, Texas, USA
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Liu P, Yang M, Cai M, Qin J, Pan L. Treatment of Pediatric Traumatic Intracranial Pseudoaneurysm Using Endovascular Covered Stent: Three Case Reports. World Neurosurg 2015; 88:693.e1-693.e6. [PMID: 26724623 DOI: 10.1016/j.wneu.2015.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/08/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pediatric traumatic intracranial pseudoaneurysm (TIPA) is a relatively rare clinical entity resulting from blunt, penetrating, or iatrogenic head trauma. The diagnosis, management, and prognosis of patients with pediatric TIPA is not well understood. Surgical craniotomy for TIPA is a high-risk operation. Advancements in minimally invasive technology have allowed for endovascular reconstruction of TIPA. CASE DESCRIPTION We present our experience with use of endovascular covered stents for treatment of 3 pediatric patients with TIPA. The clinical and radiologic characteristics are presented. No procedure-related complications or deaths occurred during follow-up. CONCLUSIONS In this study, the use of the Willis covered stent was associated with favorable prognoses in 3 patients with TIPA. No major complications were encountered during follow-up. The Willis covered stent appears to be a viable therapeutic modality in these patients. A definitive prognosis assessment will necessitate prospective clinical trials with longer duration of follow-up.
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Affiliation(s)
- Peng Liu
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Ming Yang
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Mingjun Cai
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Jie Qin
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Li Pan
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China.
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Dolati P, Eichberg DG, Thomas A, Ogilvy CS. Application of Pipeline Embolization Device for Iatrogenic Pseudoaneurysms of the Extracranial Vertebral Artery: A Case Report and Systematic Review of the Literature. Cureus 2015; 7:e356. [PMID: 26623211 PMCID: PMC4658329 DOI: 10.7759/cureus.356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traumatic pseudoaneurysms of the vertebral artery (VA) are uncommon vascular lesions and definitive management is often challenging. Between 0% and 8% of craniocervical fusions are complicated by VA injury. In these cases, preserving the vertebral artery while treating the pseudoaneurysm is the goal of any treatment option. We describe the second known case of a patient with and iatrogenic extracranial vertebral artery pseudoaneurysm treated effectively using the Pipeline Embolization Device (PED) (Ev3 Neurovascular, Irvine, CA). Although there have been only two cases reported, the use of flow-diverting stents appears to be efficacious for the treatment of non-actively bleeding traumatic pseudoaneurysms.
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Kabbasch C, Bangard C, Liebig T, Majd P, Mpotsaris A, Faymonville A. The Dual Layer Casper Micromesh Stent: Taking Advantage of Flow-Diverting Capabilities for the Treatment of Extracranial Aneurysms and Pseudoaneurysms. Cardiovasc Intervent Radiol 2015; 39:472-6. [PMID: 26231665 DOI: 10.1007/s00270-015-1193-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Christopher Bangard
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Thomas Liebig
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Payman Majd
- Department of Vascular Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Andrea Faymonville
- Department of General Neurosurgery, Center of Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Kooraki S, Grohmann J, Elshikh S, Urbach H, Meckel S. Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm. J Neurointerv Surg 2015; 8:e31. [PMID: 26122326 DOI: 10.1136/neurintsurg-2015-011760.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 12/25/2022]
Abstract
Covered stents have rarely been used in neuroendovascular procedures. We report the case of a 74-year-old woman with a complex iatrogenic vascular injury from attempted insertion of a hemodialysis catheter: concurrent brachiocephalic artery pseudoaneurysm and common carotid artery to internal jugular vein fistula. Both lesions were excluded successfully by using two balloon-expandable covered stents with a satisfactory short-term clinical and angiographic outcome.
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Affiliation(s)
- Soheil Kooraki
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of) Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Jochen Grohmann
- Department of Pediatric Cardiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Samer Elshikh
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Stephan Meckel
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
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Kooraki S, Grohmann J, Elshikh S, Urbach H, Meckel S. Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm. BMJ Case Rep 2015; 2015:bcr-2015-011760. [PMID: 26106173 DOI: 10.1136/bcr-2015-011760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Covered stents have rarely been used in neuroendovascular procedures. We report the case of a 74-year-old woman with a complex iatrogenic vascular injury from attempted insertion of a hemodialysis catheter: concurrent brachiocephalic artery pseudoaneurysm and common carotid artery to internal jugular vein fistula. Both lesions were excluded successfully by using two balloon-expandable covered stents with a satisfactory short-term clinical and angiographic outcome.
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Affiliation(s)
- Soheil Kooraki
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of) Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Jochen Grohmann
- Department of Pediatric Cardiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Samer Elshikh
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
| | - Stephan Meckel
- Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany
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Mahmoud MZ, Al-Saadi M, Abuderman A, Alzimami KS, Alkhorayef M, Almagli B, Sulieman A. "To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms. World J Radiol 2015; 7:89-99. [PMID: 26029351 PMCID: PMC4444605 DOI: 10.4329/wjr.v7.i5.89] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/31/2014] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of “to-and-fro” waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of “to-and-fro” waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of “to-and-fro” waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and “to-and-fro” flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional “to-and-fro” waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the “to-and-fro” waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.
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Hirai S, Saigusa K, Norisue Y, Nemoto S. Cerebral hyperperfusion syndrome after endovascular covered stent grafting for a giant extracranial aneurysm of the internal carotid artery. J Vasc Surg Cases 2015; 1:46-49. [PMID: 31724647 PMCID: PMC6849972 DOI: 10.1016/j.jvsc.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/23/2014] [Indexed: 11/18/2022] Open
Abstract
Symptomatic giant extracranial internal carotid artery (ICA) aneurysm is a rare and surgically intractable disease. Several authors have described successful treatments for extracranial ICA aneurysm. None, however, have described a perioperative evaluation of cerebral perfusion or a postoperative complication of cerebral hyperperfusion syndrome (CHS). We present a rare case of CHS after endovascular covered stent grafting for a giant extracranial ICA aneurysm. The CHS was successfully managed on the basis of hemodynamic monitoring. CHS can appear after endovascular reconstruction of an extracranial ICA aneurysm, and perioperative repeated evaluation of cerebral perfusion allows safe and effective management of CHS.
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Affiliation(s)
- Sakyo Hirai
- Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
- Reprint requests: Sakyo Hirai, MD, Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu-shi, Chiba, 279-0001, Japan
| | - Kuniyasu Saigusa
- Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yasuhiro Norisue
- Department of Intensive Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Shigeru Nemoto
- Department of Endovascular Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan
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Varetto G, Castagno C, Quaglino S, Garneri P, Benintende E, Gibello L, Rossato D, Rispoli P. Successful management with 2 overlapping bare stents for post-carotid endarterectomy carotid pseudoaneurysm secondary to carotid shunt. Ann Vasc Surg 2015; 29:594.e1-4. [PMID: 25637577 DOI: 10.1016/j.avsg.2014.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/17/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
Pseudoaneurysms are a rare complication of carotid endarterectomy. We successfully excluded with 2 overlapping bare stents a distal carotid artery pseudoaneurysm very likely induced by a Pruitt-Inahara shunt 2 months after carotid endarterectomy.
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Affiliation(s)
| | | | - Simone Quaglino
- Division of Vascular Surgery, University of Turin, Turin, Italy
| | - Paolo Garneri
- Division of Vascular Surgery, University of Turin, Turin, Italy
| | | | - Lorenzo Gibello
- Division of Vascular Surgery, University of Turin, Turin, Italy
| | - Denis Rossato
- Division of Radiology, University of Turin, Turin, Italy
| | - Pietro Rispoli
- Division of Vascular Surgery, University of Turin, Turin, Italy.
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Abstract
Epistaxis is commonly encountered in otorhinolaryngologic practice. However, severe and recurrent epistaxis is rarely seen, especially that originating from a pseudoaneurysm of the intracavernous internal carotid artery (ICA). We herein present the case of a 32-year-old man who was involved in a motor vehicle accident and subsequently developed recurrent episodes of profuse epistaxis for the next three months, which required blood transfusion and nasal packing to control the bleeding. Computed tomography angiography revealed a large intracavernous ICA pseudoaneurysm measuring 1.7 cm × 1.2 cm × 1.0 cm. The patient underwent emergent four-vessel angiography and coil embolisation and was discharged one week later without any episode of bleeding. He remained asymptomatic after three-month and one‑year intervals. This case report highlights a large intracavernous ICA pseudoaneurysm as a rare cause of epistaxis, which requires a high index of suspicion in the right clinical setting and emergent endovascular treatment to prevent mortality.
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Affiliation(s)
- Radhika Sridharan
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia.
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Yeh CH, Chen YL, Wu YM, Huang YC, Wong HF. Anatomically based approach for endovascular treatment of vertebro-vertebral arteriovenous fistula. Interv Neuroradiol 2014; 20:766-73. [PMID: 25496689 DOI: 10.15274/inr-2014-10072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/27/2014] [Indexed: 11/12/2022] Open
Abstract
Vertebro-vertebral arteriovenous fistula (VV-AVF) is a rare vascular disorder with an abnormal high-flow shunt between the extracranial vertebral artery (VA), its muscular or radicular branches and an adjacent vein. To date, there are no guidelines on the best treatment for VV-AVF. We present our experience of VV-AVF treatment with covered stents in three patients and detachable coils in two patients. One patient with fistula at the V3 segment had rapid fistula recurrence one week after covered stent treatment. The possible causes of failed treatment in this patient are discussed. The currently available treatment modalities for VV-AVF are also summarized after a literature review. At the end of this article, we propose a new concept of anatomically based approach for endovascular treatment of VV-AVF. Fistula in the V1-2 segments of vertebral artery could be treated safely and effectively by covered stent with the benefit of preserving VA patency. Embolization with variable embolizers should be considered first for fistula in the V3 segment because of the tortuous course and flexibility of the VA in this segment.
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Affiliation(s)
- Chih-Hua Yeh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital; Keelung, Taiwan - Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan - ;
| | - Yao-Liang Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital; Keelung, Taiwan - Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan
| | - Yi-Ming Wu
- Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan
| | - Yu-Chieh Huang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital; Keelung, Taiwan - Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan
| | - Ho-Fai Wong
- Division of Neuroradiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou, Taiwan - College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan
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Ergun O, Celtikci P, Canyigit M, Birgi E, Hidiroglu M, Hekimoglu B. Covered stent-graft treatment of a postoperative common carotid artery pseudoaneurysm. Pol J Radiol 2014; 79:333-6. [PMID: 25279023 PMCID: PMC4181305 DOI: 10.12659/pjr.890751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/01/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Extracranial carotid artery pseudoaneurysms are rare cases resulting from trauma, mycotic infection, head and neck carcinomas or complications related to their treatment. Trauma is the most common cause of carotid artery pseudoaneurysms. They can also present after surgery, most commonly following endarterectomy, which is a rare cause with an estimated incidence of 0.3-0.6%. CASE REPORT A 26-year-old male patient was admitted with swelling in his left neck after left carotid endarterectomy. Angiography confirmed pseudoaneursym in the left carotid bulb and it was treated successfully with two heparin-bonded covered stent grafts. CONCLUSIONS Endovascular treatment of carotid pseudoaneurysms with covered stent-grafts is a safe and efficient method providing definitive arterial reconstruction. But series with longer follow-up periods are needed to evaluate patient compatibility to lifelong antiplatelet theraphy.
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Affiliation(s)
- Onur Ergun
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Pinar Celtikci
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Murat Canyigit
- Department of Radiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Erdem Birgi
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mete Hidiroglu
- Department of Cardiovascular Surgery, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Baki Hekimoglu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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