Endovascular repair of traumatic pseudoaneurysm by uncovered self-expandable stenting with or without transstent coiling of the aneurysm cavity

Various surgical options for internal carotid or subclavian artery pseudoan eurysm repair have been reported; however, in general they have resulted in poor outcomes with high morbidity and mortality rates. Recently, these ope n surgical procedures have been partly replaced by percutaneous translumina l placement of endovascular devices. We evaluated the potential for using f lexible self-expanding uncovered stents with or without coiling to treat ex tracranial internal carotid, subclavian and other peripheral artery posttra umatic pseudoaneurysm Three patients with posttraumatic pseudoaneurysm were treated by stent deployment and coiling (two cases) of the aneurysm cavity . In one case, a 5.0 x 47 mm Wallstent (Boston Scientific) was positioned t o span the neck of the 9 x 5 mm size pseudoaneurysm (left internal carotid artery) and deployed. Angiography demonstrated complete occlusion of the ps eudoaneurysm without coiling. In the second patient, a 5.0 x 31 mm Wallsten t (Boston Scientific) was positioned to span the neck of the 9 x 7 mm size pseudoaneurysm (right internal carotid artery) and deployed. A total of six coils (Guglielmi Detachable Coils, Boston Scientific) were deployed into t he pseudoaneurysm cavity until it was completely obliterated. In the third case, an 8.0 x 80 mm SMART (Cordis) stent was advanced over the wire, posit ioned to span the neck of the 10 x 7 mm size pseudoaneurysm of the left sub clavian artery, and deployed. Fourteen 40 x 0.5 mm Trufill (Cordis) pushabl e coils were deployed into the pseudoaneurysm cavity until it was completel y obliterated. At long-term follow-up (6-9 months), all patients were asymp tomatic without flow into the aneurysm cavity by Duplex ultrasound. We conc lude that uncovered endovascular flexible self-expanding stent placement wi th transstent coil embolzation of the pseudoaneurysm cavity is a promising new technique to treat posttraumatic pseudoaneurysm vascular disease by min imally invasive methods, while preserving the patency of the vessel and sid e branches. (C) 2001 Wiley-Liss, Inc.