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Case Reports
. 2023 Dec 26:8:17.
doi: 10.21037/acr-23-56. eCollection 2024.

Balloon-mounted covered stent as endovascular management of a traumatic cervical internal carotid artery pseudoaneurysm in a 23-year-old: a case report

Ahmed Abdelsalam  1 , Vasu Saini  1 , Tiffany Eatz  1 , Michael A Silva  1 , Evan M Luther  1 , Miguel Bandes  1 , John W Thompson  1 , Ian A Ramsay  1 , Joshua D Burks  1 , Hayes B Fountain  1 , Robert M Starke  1
Affiliations
Case Reports

Balloon-mounted covered stent as endovascular management of a traumatic cervical internal carotid artery pseudoaneurysm in a 23-year-old: a case report

Ahmed Abdelsalam et al. AME Case Rep. .

Abstract

Background: Distal cervical internal carotid artery (cICA) pseudoaneurysms are uncommon. They may lead to thromboembolic or hemorrhagic complications, especially in young adults. We report one of the first cases in the literature regarding the management via PK Papyrus (Biotronik, Lake Oswego, Oregon, USA) balloon-mounted covered stent of a 23-year-old male with an enlarging cervical carotid artery pseudoaneurysm and progressive internal carotid artery stenosis.

Case description: We report the management of a 23-year-old male with an enlarging cervical carotid artery pseudoaneurysm and progressive internal carotid artery stenosis. Based on clinical judgment and imaging analysis, the best option to seal the aneurysm was a PK Papyrus 5×26 balloon-mounted covered stent. A follow-up angiogram showed no residual filling of the pseudoaneurysm, but there was some contrast stagnation just proximal to the stent, which is consistent with a residual dissection flap. We then deployed another PK Papyrus 5×26 balloon-mounted covered stent, providing some overlap at the proximal end of the stent. An angiogram following this subsequent deployment demonstrated complete reconstruction of the cICA with no residual evidence of pseudoaneurysm or dissection flap. There were no residual in-stent stenosis or vessel stenosis. The patient was discharged the day after the procedure with no complications.

Conclusions: These positive outcomes support the use of a balloon-mounted covered stent as a safe and feasible modality with high technical success for endovascular management of pseudoaneurysm.

Keywords: Cervical internal carotid artery (cICA); case report; covered stent; endovascular management; pseudoaneurysm.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://acr.amegroups.com/article/view/10.21037/acr-23-56/coif). R.M.S.’s research is supported by the Neurosurgery Research & Education Foundation (NREF), Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and by National Institute of Health (NIH) (No. R01NS111119-01A1) and (No. UL1TR002736 and KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. R.M.S. has an unrestricted research grant from Medtronic and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter and Optimize Vascular. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Right distal cervical internal carotid artery pseudoaneurysm measuring 1.7 cm with 60% luminal stenosis: (A) lateral view; (B) anteroposterior view.
Figure 2
Figure 2
The PK Papyrus 5×26 balloon-mounted covered stent (Biotronik, Lake Oswego, Oregon, USA).
Figure 3
Figure 3
The PK Papyrus 5×26 balloon-mounted covered stent deployed across the distal cervical internal carotid artery (A) with arrows indicating expanse of stent (B).
Figure 4
Figure 4
Complete coverage of the distal cervical internal carotid artery pseudoaneurysm neck with no residual filling by the Papyrus covered stent (no residual in-stent stenosis).
Figure 5
Figure 5
Absence of the pseudoaneurysm and dissection on the 6-month follow-up cerebral angiogram (left) and 3D angiography (right). 3D, three-dimensional.
See this image and copyright information in PMC

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