Use of covered stent grafts in the extracranial carotid artery: report of three patients with follow-up between 8 and 42 months

Abstract

Currently, most carotid artery pathologic abnormalities resulting in pseudoaneurysm formation or stenosis are repaired by surgical intervention. Because surgical intervention requires proximal and distal control of the artery, pseudoaneurysms near the skull base may be very difficult to repair and pose greater risk to the patient. As a result, endovascular techniques have evolved in an effort to reduce morbidity associated with surgical techniques. Parent vessel occlusion and coil placement are the most frequently used endovascular techniques for carotid artery repair of pseudoaneurysms. Intimal hyperplasia is generally treated with balloon angioplasty, often in conjunction with uncovered stent placement. Parent vessel occlusion may be impractical if the patient is unable to tolerate occlusion of that artery. We report our experience in treating three patients with carotid artery stent grafts.

Fig 1.

Images obtained in patient 1, a 31-year-old woman who presented with an acutely enlarging left neck mass. A, Selective arteriogram of the left common carotid artery shows a large pseudoaneurysm of the left internal carotid artery with contrast material extravasation. B, Covered stent graft is placed across the neck of the pseudoaneurysm. C, Arteriogram obtained after stent graft placement shows occlusion of the pseudoaneurysm from the internal carotid artery.

Fig 2.

Images obtained in patient 2, a 23-year-old man who presented with gunshot wounds to the skull and neck. A, Selective left internal carotid arteriogram shows a posttraumatic pseudoaneurysm near the skull base. B, Selective left internal carotid artery injection shows a stent across the pseudoaneurysm, with multiple coils within the pseudoaneurysm. Minimal residual flow is noted in the pseudoaneurysm. C, Selective injection of the internal carotid artery shows a recurrent pseudoaneurysm. D, Selective common carotid artery injection shows the covered stent grafts in place with occlusion of the pseudoaneurysm. E, Injection of the common carotid artery performed 8 months after stent graft placement shows continued occlusion of the pseudoaneurysm.

Fig 3.

Images obtained in patient 3, a 63-year-old woman who had undergone three carotid endarterectomies. A, Selective arteriogram of the right common carotid artery shows moderate stenosis at the midportion of the previously deployed wall stent. B, Covered stent graft is placed overlying the midportion of the wall stent. Angiogram obtained after stent graft shows no evidence of stenosis.