Endoluminal stent placement and coil embolization for the management of carotid artery pseudoaneurysms

Purpose: To present a series of carotid artery pseudoaneurysms treated succ essfully using an endovascular approach. Methods: From April 1995 to November 1999, 5 patients with neurological sym ptoms not explained by computed tomography of the head were identified by c arotid angiography as having internal carotid artery (ICA) pseudoaneurysms. Three patients had sustained blunt trauma, and 2 had previous elective car otid endarterectomies for atherosclerotic disease. The time between injury and treatment ranged from 3 days to 10 years. The patients were treated wit h endovascular stent placement for exclusion of the pseudoaneurysm, followe d by filling of the cavity with multiple detachable coils. Patients were ma intained on oral antiplatelet agents or anticoagulant therapy after the pro cedure. Results: Primary technical success was 100%. No patient suffered permanent neurological sequelae. Postprocedure angiography demonstrated a patent ICA in all cases, with complete obliteration of the pseudoaneurysm. At a mean 8 .4-month follow-up (range 2-21), all patients remained symptom free; angiog rams in 3 patients at a mean 11.7 months demonstrated continued ICA patency . One patient had a 60% focal narrowing of the distal common carotid artery , which was treated successfully with balloon dilation and stenting. Conclusions: Endovascular treatment of carotid artery pseudoaneurysms is a useful alternative to standard surgical repair. This modality avoids the ne cessity for surgical exposure at the skull base with its inherent morbidity .