Ultrasound-Guided Percutaneous Thrombin Injection of Common Carotid Pseudoaneurysm following Carotid Endarterectomy is Possible

Abstract

Pseudoaneurysm (PSA) of the carotid artery is a rare complication of carotid endarterectomy (CEA) with an incidence of less than 1%. PSAs of other named arteries are commonly treated with ultrasound-guided thrombin injection; however, there are few accounts in the literature discussing the use of this technique for the treatment of carotid PSA, specifically, and none for carotid PSA after CEA. We present the case of an 86-year-old woman with a left common carotid artery PSA, which was noted after left CEA. As emergent treatment, ultrasound-guided direct percutaneous thrombin injection was used without embolic protection. This produced immediate thrombosis of the PSA, without complication. Arterial duplex at long-term follow-up demonstrated sustained PSA closure and patency of the carotid artery system. We report our case and review of the very limited available literature on this procedure.