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Case Reports
. 2013 Sep;19(3):313-9.
doi: 10.1177/159101991301900308. Epub 2013 Sep 26.

Endovascular treatment of a mycotic intracavernous carotid artery aneurysm using a stent graft

Vivek Gupta  1 , Vikash Jain, S N Mathuria, N Khandelwal
Affiliations
Case Reports

Endovascular treatment of a mycotic intracavernous carotid artery aneurysm using a stent graft

Vivek Gupta et al. Interv Neuroradiol. 2013 Sep.

Abstract

Intracavernous carotid artery mycotic aneurysms are rare and management is determined by clinical presentation. We describe the first documented proximal intracranial mycotic aneurysm treated by a balloon expandable Aneugraft PCS covered stent. An 11-year-old female child presented with acute onset fever, headache, chemosis followed by diplopia, right-sided ptosis with ophthalmoplegia. Magnetic resonance imaging revealed bilateral cavernous sinus thrombosis. Subsequent work-up included serial computed tomographic arteriography and digital subtraction angiography which revealed a progressively enlarging intracavernous carotid aneurysm. An Aneugraft PCS covered stent was successfully deployed endovascularly, and complete exclusion of the aneurysm was achieved while maintaining the patency of the parent artery. The use of covered stents in intracranial vasculature can be an effective and safe treatment modality for exclusion of the mycotic aneurysm in selected cases.

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Figures

Figure 1
Figure 1
T2 W axial (A) and post gadolinium T1 W axial (B) sections of the orbit and cavernous sinuses reveal expansion of the bilateral cavernous sinuses with lateral convex margin and multiple filling defects on post contrast images suggestive of bilateral cavernous sinus thrombosis. Also seen is some soft tissue in the left sphenoid sinus suggestive of sinusitis.
Figure 2
Figure 2
CT angiography of the brain (MIP images) after 2 weeks reveal a right intracavernous internal carotid artery aneurysm measuring 13.2×14.1×10.2 mm.
Figure 3
Figure 3
A) Angiogram at presentation showing the aneurysm with narrowed ICA segment. B) Follow-up angiogram after a month demonstrating an enlarged aneurysm and reduced narrowing of the ICA.
Figure 4
Figure 4
A,B) The microwire is negotiated beyond the aneurysm and a balloon expandable stent graft (Aneugraft PCS) deployed over it. C) The post-stenting angiogram shows slight residual filling of the aneurysm. D) Final check angiogram after the 2nd balloon inflation revealed non opacification of the aneurysm with patent cavernous ICA.
Figure 5
Figure 5
Follow-up CT angiography at 1 week confirmed ICA patency at the level of the stent-graft, with non opacification of the aneurysmal sac.
See this image and copyright information in PMC

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