ABSTRACT
BACKGROUND: Delayed presentation of carotid artery pseudoaneurysm following many years after self-inflicted penetrating injury of the neck is extremely rare. Open surgical carotid repair may involve sternotomy for proximal vascular control. Endovascular treatment is evolving as a less-invasive treatment option. METHODS: We report a 55-year-old man with a history of paranoid schizophrenia who presented with a progressively enlarging left sided neck mass many years after attempted suicide. CT scan confirmed a 6 cm pseudoaneurysm arising from the common carotid artery. RESULTS: Through an open retrograde puncture of the distal common carotid artery, the common carotid pseudoaneurysm was successfully repaired with a BARD fluency carotid stentgraft of 8 mm×80 mm (BARD, Tempe, AZ). The patient recovered well with no neurological deficits and was discharged on postoperative day 4. Dual antiplatelet agents of aspirin and clopidogrel were given for six months and then clopidogrel was administered lifelong. The neck mass decreased in size gradually and became non pulsatile upon follow-up. CONCLUSION: Endovascular stenting of giant carotid pseudoaneurysm is an acceptable less invasive treatment option for giant carotid pseudoaneurysm. Long-term follow-up and a greater number of cases are mandatory to establish the safety of this strategy.
ABSTRACT
Los pseudoaneurismas de la arteria carótida interna son una complicación poco frecuente de traumatismos penetrantes o cerrados, y por lo general de tratamiento quirurgico difícil, debido a que la resolución por esta técnica requiere de amplia exposición cervical, que puede conllevar a daño de uno o varios nervios craneales o de otras extructuras incluidas las vasculares. El diagnóstico puede retardarse si el traumatismo es no penetrante. El usio de stent cubiertos es relativamente nuevo y lucen como una alternativa atractiva. Los pseudoaneurismas tienen alto riesgo de tromboembolismo por lo qu el diagnóstico oportuno es importante. Los stents cubiertos del tipo autoexpandible surgen como una alternativa interesante al tratamiento quirúrgico, con una tasa muy baja de complicaciones. Es necesario dar al paciente una antiagregaciòn plaquetaria dual (aspirina y clopidogrel) o anticoagulación.
Internal carotid artery pseudo aneurysms are a rare complication following blunt or penetrating trauma and its surgical treatment is difficult, because if they are resolved by surgery they need a large cervical exposure, wich could cause cranial nerve damage or damage of structures, such as the vasculature. The use of stent-graft is relatively new and it appears as an attractive alternative. Pseudo aneurysms have a high risk of thromboembolism, so its early detection is important. Auto-expandable Stent- grafts are an attractive alternative to surgical treatment, with a low incident of complications. It is necessary to give the patient dual antiplatelet treatment (Aspirin plus Clopidogrel) or anticoagulation. There are not studies with follow up to determine its safety and efficacy.