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Title: Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts

Abstract

Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery.

Authors:
; ;  [1];  [2];  [3];  [1]
  1. Hospital HOSPITEN, Department of Endovascular Therapy (Spain)
  2. Hospital HOSPITEN, Department of Cardiovascular Surgery (Spain)
  3. Medical University of South Carolina, Department of Radiology, Heart and Vascular Center, South Carolina (United States)
Publication Date:
OSTI Identifier:
21090648
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 31; Journal Issue: 2; Other Information: DOI: 10.1007/s00270-006-0245-y; Copyright (c) 2008 Springer Science+Business Media, LLC; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIFURCATION; CAROTID ARTERIES; PATIENTS; POLYTETRAFLUOROETHYLENE; SKULL; SURGERY

Citation Formats

Baldi, Sebastian, E-mail: sebaldi73@yahoo.com, Rostagno, Roman D., Zander, Tobias, Llorens, Rafael, Schonholz, Claudio, and Maynar, Manuel. Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts. United States: N. p., 2008. Web. doi:10.1007/S00270-006-0245-Y.
Baldi, Sebastian, E-mail: sebaldi73@yahoo.com, Rostagno, Roman D., Zander, Tobias, Llorens, Rafael, Schonholz, Claudio, & Maynar, Manuel. Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts. United States. doi:10.1007/S00270-006-0245-Y.
Baldi, Sebastian, E-mail: sebaldi73@yahoo.com, Rostagno, Roman D., Zander, Tobias, Llorens, Rafael, Schonholz, Claudio, and Maynar, Manuel. 2008. "Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts". United States. doi:10.1007/S00270-006-0245-Y.
@article{osti_21090648,
title = {Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts},
author = {Baldi, Sebastian, E-mail: sebaldi73@yahoo.com and Rostagno, Roman D. and Zander, Tobias and Llorens, Rafael and Schonholz, Claudio and Maynar, Manuel},
abstractNote = {Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery.},
doi = {10.1007/S00270-006-0245-Y},
journal = {Cardiovascular and Interventional Radiology},
number = 2,
volume = 31,
place = {United States},
year = 2008,
month = 3
}
  • Aneurysms of the extracranial carotid arteries (ECAA) are extremely rare. Schechter et al. documented 835 cases in the literature up to 1977. One hundred and sixteen cases of ECAA have been documented in the Chinese literature since 1981, suggesting a higher prevalence of carotid aneurysmal disease in China than in the West. Four percent of all peripheral artery aneurysms are reported to be ECAA. Those arising from the internal carotid artery (EICAA) are even more rare. Two recent reviews reported 24 and 25 cases of EICAA during 21 and 17 years, respectively, the majority of them is treated surgically. Ourmore » literature review revealed only a few true EICAA managed endovascularly, but none of them with a covered stent. We describe a rare such case of ruptured atherosclerotic EICAA which was treated percutaneously.« less
  • Internal carotid artery pseudoaneurysm is a rare life-threatening condition that may develop in different clinical situations. We report the case of an extracranial internal carotid artery pseudoaneurysm secondary to a throat infection in a pediatric patient that was initially treated with percutaneous thrombin injection under ultrasound guidance. However, recanalization occurred at 48 h, and definitive treatment was then performed by endovascular stent-graft placement. We briefly review the clinical characteristics of this uncommon clinical condition as well as the treatment options.
  • Dissecting pseudoaneurysm of the extracranial portion of the internal carotid artery (ICA) is a usually benign complication of spontaneous ICA dissection. We report a case in which pseudoaneurysm volume enlarged progressively and new clinical symptoms developed 9 months following disease onset. Placement of a coronary stent-graft resulted in immediate complete resolution of clinical symptoms and radiologic restoration of normal flow.
  • Complex peripheral aneurysm anatomy with major artery branches in the immediate vicinity and mycotic aneurysm often impede endovascular management using covered stent grafts. The Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) is a recently approved innovative stent system for peripheral aneurysm management. Its multilayer design aims at decreasing mean velocity and vorticity within the aneurysm sac to cause thrombus formation while maintaining patency of branching vessels due to laminar flow. We present a case of bilateral subclavian artery aneurysms and perivisceral aortic aneurysms in an AIDS patient successfully treated with the Cardiatis Multilayer Stent at 18 months' follow-up.
  • The purpose of this study was to evaluate the feasibility, safety and midterm outcome of elective implantation of the Carotid Wallstent (registered) in patients considered to be at high surgical risk. In a prospective study, 54 carotid artery stenoses in 51 patients were stented over a 24-month period. Three patients underwent bilateral carotid artery stenting. Institutional inclusion criteria for invasive treatment of carotid occlusive disease (carotid endarterectomy or carotid artery stenting) are patients presenting with a 70% or more symptomatic stenosis and those with an 80% or more asymptomatic stenosis having a life-expectancy of more than 1 year. All patientsmore » treated by carotid artery stenting were considered at high risk for carotid endarterectomy because of a hostile neck (17 patients-31.5%) or because of severe comorbidities (37 patients-68.5%). No cerebral protection device was used. Of the 54 lesions, 33 (61.1%) were symptomatic and 21 (38.8%) were asymptomatic. Follow-up was performed by physical examination and by duplex ultrasonography at 1 month, 6 months, 1 year and 2 years after the procedure. All 54 lesions could be stented successfully without periprocedural stroke. Advert events during follow-up (mean 13.9 {+-} 5.7 months) were non-stroke-related death in 6 patients (11.1%), minor stroke in 4 stented hemispheres(7.4%), transient ipsilateral facial pain in 1 patient (1.8%),infection of the stented surgical patch in 1 patient (1.8%) and asymptomatic in stent restenosis in 4 patients (7.4%). The percutaneous implantation of the Carotid Wallstent (registered) , even without cerebral protection device, appears to be a safe procedure with acceptable clinical and ultrasonographic follow-up results in patients at high surgical risk. But some late adverse events such as ipsilateral recurrence of non-disabling (minor) stroke or in stent restenosis still remain real challenging problems.« less