Treatment of an latrogenic petrous carotid artery pseudoaneurysm with a symbiot covered stent: Technical case report

Michael J. Alexander, Tony P. Smith, Debara L. Tucci, Donald W. Larsen, L. Nelson Hopkins, Bernard Bendok, Alan S. Boulos, Elad I. Levy, Bernd Richling

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: Surgery involving the middle ear or the temporal bone may cause an injury to the petrous carotid artery resulting in a pseudoaneurysm. Conventional treatment of such pseudoaneurysms has ranged from carotid occlusion to conservative management. The use of a balloon-expandable stent and/or Guglielmi detachable coils may be effective in a partially healed pseudoaneurysm. This report details the case of an acute petrous carotid pseudoaneurysm after a myringotomy procedure that was effectively treated with an expanded polytetrafluoroethylene-covered stent. CLINICAL PRESENTATION: During a right myringotomy procedure, pulsatile blood was encountered in a 42-year-old woman with a history of repeated ear infections and bilateral middle ear ventilation tube placement. The blood was adequately tamponaded with gauze packing. Computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and cerebral angiography revealed a 6-mm right petrous carotid pseudoaneurysm. INTERVENTION/TECHNIQUE: An 8-French guide catheter was positioned via a transfemoral approach into the cervical right internal carotid artery, and the patient was systemically heparinized. A 4- × 31-mm Symbiot covered stent (Boston Scientific/Scimed, Maple Grove, MN) was passed over a Choice PT exchange wire (Boston Scientific/Scimed) to cover the neck of the pseudoaneurysm, obliterating the pseudoaneurysm. The patient was given aspirin and clopidogrel after stenting, and ear exploration was possible later the same day. Follow-up computed tomographic angiography performed 6 weeks later verified patency of the stent. CONCLUSION: The use of an expanded polytetrafluoroethylene-covered stent may effectively treat intracranial internal carotid artery pseudoaneurysms in an acute setting. This treatment allows preservation of the parent artery and immediate treatment by reconstruction of the incompetent arterial wall to prevent potentially life-threatening hemorrhagic complications.

Original languageEnglish (US)
Pages (from-to)658-662
Number of pages5
JournalNeurosurgery
Volume50
Issue number3
DOIs
StatePublished - Mar 1 2002
Externally publishedYes

Fingerprint

Carotid Artery Injuries
False Aneurysm
Carotid Arteries
Stents
Temporal Bone
clopidogrel
Polytetrafluoroethylene
Internal Carotid Artery
Ear
Middle Ear Ventilation
Acer
Therapeutics
Cerebral Angiography
Middle Ear
Aspirin
Angiography
Catheters
Arteries
Tomography
Wounds and Injuries

Keywords

  • Carotid dehiscence
  • Expanded polytetrafluoroethylene-covered stent
  • Petrous carotid artery
  • Pseudoaneurysm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Treatment of an latrogenic petrous carotid artery pseudoaneurysm with a symbiot covered stent : Technical case report. / Alexander, Michael J.; Smith, Tony P.; Tucci, Debara L.; Larsen, Donald W.; Hopkins, L. Nelson; Bendok, Bernard; Boulos, Alan S.; Levy, Elad I.; Richling, Bernd.

In: Neurosurgery, Vol. 50, No. 3, 01.03.2002, p. 658-662.

Research output: Contribution to journalArticle

Alexander, MJ, Smith, TP, Tucci, DL, Larsen, DW, Hopkins, LN, Bendok, B, Boulos, AS, Levy, EI & Richling, B 2002, 'Treatment of an latrogenic petrous carotid artery pseudoaneurysm with a symbiot covered stent: Technical case report', Neurosurgery, vol. 50, no. 3, pp. 658-662. https://doi.org/10.1097/00006123-200203000-00047
Alexander, Michael J. ; Smith, Tony P. ; Tucci, Debara L. ; Larsen, Donald W. ; Hopkins, L. Nelson ; Bendok, Bernard ; Boulos, Alan S. ; Levy, Elad I. ; Richling, Bernd. / Treatment of an latrogenic petrous carotid artery pseudoaneurysm with a symbiot covered stent : Technical case report. In: Neurosurgery. 2002 ; Vol. 50, No. 3. pp. 658-662.
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AU - Larsen, Donald W.

AU - Hopkins, L. Nelson

AU - Bendok, Bernard

AU - Boulos, Alan S.

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N2 - OBJECTIVE AND IMPORTANCE: Surgery involving the middle ear or the temporal bone may cause an injury to the petrous carotid artery resulting in a pseudoaneurysm. Conventional treatment of such pseudoaneurysms has ranged from carotid occlusion to conservative management. The use of a balloon-expandable stent and/or Guglielmi detachable coils may be effective in a partially healed pseudoaneurysm. This report details the case of an acute petrous carotid pseudoaneurysm after a myringotomy procedure that was effectively treated with an expanded polytetrafluoroethylene-covered stent. CLINICAL PRESENTATION: During a right myringotomy procedure, pulsatile blood was encountered in a 42-year-old woman with a history of repeated ear infections and bilateral middle ear ventilation tube placement. The blood was adequately tamponaded with gauze packing. Computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and cerebral angiography revealed a 6-mm right petrous carotid pseudoaneurysm. INTERVENTION/TECHNIQUE: An 8-French guide catheter was positioned via a transfemoral approach into the cervical right internal carotid artery, and the patient was systemically heparinized. A 4- × 31-mm Symbiot covered stent (Boston Scientific/Scimed, Maple Grove, MN) was passed over a Choice PT exchange wire (Boston Scientific/Scimed) to cover the neck of the pseudoaneurysm, obliterating the pseudoaneurysm. The patient was given aspirin and clopidogrel after stenting, and ear exploration was possible later the same day. Follow-up computed tomographic angiography performed 6 weeks later verified patency of the stent. CONCLUSION: The use of an expanded polytetrafluoroethylene-covered stent may effectively treat intracranial internal carotid artery pseudoaneurysms in an acute setting. This treatment allows preservation of the parent artery and immediate treatment by reconstruction of the incompetent arterial wall to prevent potentially life-threatening hemorrhagic complications.

AB - OBJECTIVE AND IMPORTANCE: Surgery involving the middle ear or the temporal bone may cause an injury to the petrous carotid artery resulting in a pseudoaneurysm. Conventional treatment of such pseudoaneurysms has ranged from carotid occlusion to conservative management. The use of a balloon-expandable stent and/or Guglielmi detachable coils may be effective in a partially healed pseudoaneurysm. This report details the case of an acute petrous carotid pseudoaneurysm after a myringotomy procedure that was effectively treated with an expanded polytetrafluoroethylene-covered stent. CLINICAL PRESENTATION: During a right myringotomy procedure, pulsatile blood was encountered in a 42-year-old woman with a history of repeated ear infections and bilateral middle ear ventilation tube placement. The blood was adequately tamponaded with gauze packing. Computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and cerebral angiography revealed a 6-mm right petrous carotid pseudoaneurysm. INTERVENTION/TECHNIQUE: An 8-French guide catheter was positioned via a transfemoral approach into the cervical right internal carotid artery, and the patient was systemically heparinized. A 4- × 31-mm Symbiot covered stent (Boston Scientific/Scimed, Maple Grove, MN) was passed over a Choice PT exchange wire (Boston Scientific/Scimed) to cover the neck of the pseudoaneurysm, obliterating the pseudoaneurysm. The patient was given aspirin and clopidogrel after stenting, and ear exploration was possible later the same day. Follow-up computed tomographic angiography performed 6 weeks later verified patency of the stent. CONCLUSION: The use of an expanded polytetrafluoroethylene-covered stent may effectively treat intracranial internal carotid artery pseudoaneurysms in an acute setting. This treatment allows preservation of the parent artery and immediate treatment by reconstruction of the incompetent arterial wall to prevent potentially life-threatening hemorrhagic complications.

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KW - Pseudoaneurysm

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