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Preliminary Experience with Endovascular Reconstruction for the Management of Carotid Blowout Syndrome

Walter S. Lesleya, John C. Chaloupkaa, John B. Weigelea, Sundeep Manglaa and Mohammad A. Dogara

a From the University of Iowa Hospitals and Clinics, Department of Radiology, Division of Neuro-Interventional Radiology, Iowa City, IA



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  		FIG 1. Endovascular treatment of traumatic ICA pseudoaneurysm.

A, Initial angiogram reveals a large pseudoaneurysm at the carotid canal.

B, After endovascular repair with GDCs, a small aneurysmal neck remnant remains (arrow).

C, GDC packing and aneurysmal growth are noted on the 10-month follow-up angiogram; note coil herniation into middle cranial fossa (arrow). The aneurysmal remnant could not be fully packed with GDCs without the use of endovascular stent reconstruction.

D, As a result, a stent was placed at the aneurysmal orifice (arrow) and was deployed.

E, Additional GDCs could then be detached to complete the repair.



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  		FIG 2. Endovascular treatment of HNC-related CBS by use of the self-expanding, covered Wallgraft stent.

A, Initial angiogram reveals a stump (arrow) at the proximal external carotid artery.

B, Microcatheter injection of the stump during endovascular exploration confirms a pseudoaneurysm as the source of hemorrhage.

C, An 8 x 30 mm Wallgraft stent is positioned within the common carotid artery and ICA junction, bridging the external carotid artery origin.

D, After deploying the stent, angiography shows exclusion of the pseudoaneurysm and normal caliber of the parent, stented artery.

E, Digital subtraction angiogram mask is shown for detail.

F, Photograph of the Wallgraft stent is shown for detail.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X