A rare vascular complication of Eagle syndrome highlight by CTA with neck flexion.

We report a case of a 53-year-old woman admitted to the emergency department with left hemiplegia, tinnitus and palpitations. A cerebral and cervical computed tomography angiography revealed an acute large ischemic stroke on the right Sylvian territory, which was related to a dissection of the right internal carotid. Moreover, a left internal carotid pseudo-aneurysm was observed. These two injuries were presumably imputable to a bilateral Eagle Syndrome. Indeed, the temporal styloid processes were measured at 31mm on both sides. To support our hypothesis of a stylocarotid impingement, a cervical CTA with hyperflexion (45°) of the neck was performed. It clearly revealed the bilateral impingement between the styloid processes and internal carotids. It seems important to know that Eagle syndrome may lead to disabling diseases or even death as well as an ischemic stroke. The vascular impingement with bilateral vascular injuries was never described. To our knowledge, our "neck flexion cervical CTA" to reveal the stylocarotid impingement has never been described before. This approach could lead to a new investigation technique, to better identify this underestimated pathology in the medical doctors community.

Endovascular treatment of intracranial aneurysms with the Woven EndoBridge device: mid term and long term results.

PURPOSE: To evaluate the clinical and anatomical results of treatment of intracranial aneurysms (IA) with the Woven EndoBridge (WEB) device, with emphasis on mid term and long term follow-up. METHODS: Between November 2010 and November 2015, we retrospectively identified, in our prospectively maintained database, all patients treated by WEB device placement for an IA at three institutions. Clinical charts, procedural data, and angiographic results were reviewed. RESULTS: 48 patients with 49 IAs were identified. There were 35 women and 13 men with a mean age of 57 years (range 35-76 years). All IA were wide necked. Mean aneurysm size was 8.6 mm. There were 44 unruptured IA and 5 ruptured IA. During endovascular treatment (EVT), adjunctive devices were used in 22.4% of procedures. A good clinical outcome (modified Rankin Scale score ≤2) was achieved in 44/48 patients (92%). There was no mortality. Mean follow-up was 25 months (range 3-72 months; median 24 months). Between mid term and long term follow-up, occlusion was stable in 19/23 IA (82.6%), improved in 2/23 IA (8.7%), and worsened in 2/23 IA (8.7%). Retreatment was performed in 8/49 IA (16.3%). At the latest available follow-up, there were 34/47 (72.3%) complete occlusions and 13/47 (27.7%) neck remnants. CONCLUSIONS: Our study suggests that EVT of IA with the WEB device provides adequate and stable long term occlusion.