Internal Carotid Artery Pseudoaneurysms: Treatment with the Wallgraft Endoprosthesis

Abstract

Purpose:

To report several cases illustrating the feasibility and mid-term efficacy of deploying a self-expanding stent-graft to treat traumatic ruptures, pseudoaneurysms, and a spontaneous dissection of the internal carotid artery (ICA).

Case Reports:

One patient suffered a stab wound and another developed a large pseudoaneurysm years after a gunshot to the neck. The third patient presented with a spontaneous rupture in the setting of fibromuscular dysplasia, and the final patient developed a pseudoaneurysm following carotid endarterectomy in an irradiated neck. All 4 patients were successfully treated with Wallgrafts deployed in the ICA using either an open carotid (first 3 cases) or percutaneous approach (fourth patient). There were no adverse neurological events. During a mean 16-month follow-up (range 6–24), duplex ultrasound and CT scanning found no evidence of restenosis, occlusion, or persistent perfusion of the pseudoaneurysm, which was noted to decrease in all cases.

Conclusions:

The thin-walled fabric of the Wallgraft appears capable of completely excluding the pseudoaneurysm, resulting in decreased aneurysm size overtime.

Keywords

internal carotid artery trauma fibromuscular dysplasia carotid endarterectomy rupture pseudoaneurysm dissection endovascular repair Wallgraft endoprosthesis aneurysm exclusion

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