Endovascular management of internal carotid artery pseudoaneurysms: Retrospective observational study

Abstract

Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) are caused by multiple etiological factors and can involve any segment. There are no clear guidelines to select treatment options in managing these cases. A retrospective review of all patients treated for ICA PSAs by endovascular treatment was conducted. Details of clinical presentations, imaging modalities, angiographic findings and endovascular treatment were noted. Four male (57%) and three female (43%) patients were treated. Their ages ranged from ten months to 52 years old. Five patients had cervical ICA PSAs, and one patient each had PSA of petrous and paraclinoid ICA segment. Five patients had traumatic etiology, one patient had post-infective mycotic and one patient had iatrogenic PSA. The most common presentation was pulsatile neck swelling (n = 5). Two patients (n = 2) presented with massive bleeding, one patient had stroke with aphasia and transient limb weakness, while the patient with petrous PSA had tinnitus and ear pain. Parent artery occlusion (PAO) was performed in six patients (n = 6). In three patients (n = 3), we used stent grafts to trap the ICA. Two patients (n = 2) underwent PAO with coils. In one patient, we used liquid embolic agent (Histoacryl) for PAO. An aneugraft pericardium covered stent was used in one patient. All patients experienced good angiographic results, without any neurological complication. There was no re-canalization of the aneurysm on follow ups. Endovascular approach is a feasible treatment option, with multiple alternative occlusion techniques and a low complication rate. PAO still remains a simple, safe, effective treatment in selective patients.

Keywords

• Internal carotid artery (ICA)
• Pseudoaneurysms (PSAs)
• Endovascular treatment
• Covered stents/stent grafts
• Histoacryl