Endovascular treatment of carotid and vertebral pseudoaneurysms with covered stents

Abstract

Background and purpose: Endovascular treatment of vascular lesions has revolutionized the treatment of arterial pseudoaneurysms. We describe our experience in treating carotid or vertebral pseudoaneurysms with covered stents.

Materials and methods: Ten patients with carotid or vertebral pseudoaneurysms treated with self-expanding or balloon-expandable covered stents were retrospectively reviewed after we obtained institutional review board approval. Distal protection devices were not used. All patients except 1 received anticoagulation therapy. Antiplatelet therapy was used in 8 of 10 patients. Follow-up was performed from 5 days to 25 months. Patients were followed with digital subtraction angiography, CT angiography (CTA), and/or sonography (US).

Results: Pseudoaneurysm occlusion was obtained in all 10 patients. None of the pseudoaneurysms recanalized during the follow-up period. One patient had a distal embolization to the middle cerebral artery despite anticoagulation and antiplatelet therapy. One patient who did not receive any anticoagulation had stent occlusion at 4.5 months. Anticoagulation was stopped after 6 months in 2 patients with persistent stent patency and no neurologic complications for >1 year. Both US and CTA were useful for extracranial stent surveillance. CTA was helpful for intracranial stent surveillance.

Conclusion: In this small series, the use of covered stents allowed safe and effective treatment of pseudoaneurysms occurring in the cervical and cephalic segments of the carotid and vertebral arteries.

Fig 1.

An 81-year-old man (patient No. 5) with metastatic thyroid cancer, treated with radiation therapy, presented with bleeding from his tracheostomy. A, A left CCA angiogram demonstrates a large pseudoaneurysm at the tracheostomy. B, Following placement of a covered stent (Fluency, 8 × 40 mm), there is exclusion of the pseudoaneurysm. C, An aortic arch angiogram demonstrates no evidence of atherosclerotic disease.

Fig 2.

A 15-year-old adolescent boy (patient No. 2) after a motor vehicle crash. A, A right subclavian artery angiogram demonstrates a large pseudoaneurysm and laceration at the origin of the right vertebral artery. B, Following placement of a covered stent (Fluency, 7 × 40 mm), there is exclusion of the pseudoaneurysm.