Covered Stent Treatment of an Extracranial Internal Carotid Artery Pseudoaneurysm in a Three Year Old Child with 12 Years of Follow Up: A Case Report

Abstract

Introduction: Extracranial internal carotid artery (ICA) pseudoaneurysms in children, although uncommon, are life threatening. Covered stents are a good alternative treatment, as they avoid the risk of open surgery and preserve the ICA. Until recently, long term outcomes were unknown. Report: A three year old boy was hospitalised with an enlarged swelling on the left side of his neck and severe respiratory distress. He had been treated a month prior for a left deep cervical abscess, with bacteriological culture positive for Staphylococcus aureus. Computed tomography angiography (CTA) revealed a large pseudoaneurysm originating from the left ICA, approximately 2 cm above the bifurcation. A balloon expanded covered stent (Jostent Graftmaster; Abbott Vascular, Redwood City, CA, USA) was deployed via a left femoral approach, after selective angiography, to seal the carotid rupture without incident. Control angiography revealed immediate exclusion of the pseudoaneurysm and patent ICA. The bacteriological culture of the residual haematoma was negative. The child was discharged with full recovery and without neurological sequelae, under platelet anti-aggregation. He has been followed up and has remained asymptomatic for 12 years, with CTA confirmed ICA patency, without deformation or evidence of significant restenosis. Discussion: This is the first report of the long term outcome of a covered stent in a child treated at three years of age, with a 12 year follow up. The good performance of the covered stent in this case reinforces its adoption as a first line option in the treatment of extracranial ICA pseudoaneurysms in children.

Keywords

• Child
• Covered stent
• Endovascular treatment
• Extracranial internal carotid artery pseudoaneurysm
• Long term follow up