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AJNR - American Journal of Neuroradiology

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Carotid Rupture during Stent-Assisted Aneurysm Treatment

Hajime Wada^a, Michel Piotin^a, Hervé Boissonnet^b, Laurent Spelle^a, Charbel Mounayer^a and Jacques Moret^a

^a Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
^b Department of Neurosurgery, Fondation Rothschild, Paris, France

View larger version (118K): [in a new window]   FIG 1. Tridimensional representation of the right ICA, showing the dysplastic carotid siphon harboring two saccular aneurysms (arrows).

View larger version (118K): [in a new window]   FIG 2. Right ICA unsubtracted angiogram (working projection) showing the positioning of the stent (arrowheads) before inflation of the delivery balloon. The distal tip of the Luge guidewire (white arrow) is secured into the M3 segment of the right middle cerebral artery. The 6F Envoy guiding catheter (black arrow) has been navigated up to the skull base.

View larger version (118K): [in a new window]   FIG 3. Right ICA subtracted control angiogram (working projection) immediately after the stent delivery, showing the massive contrast medium extravasation in keeping with the ruptured carotid.

View larger version (118K): [in a new window]   FIG 4. The stent delivery balloon (white arrow) has been reinflated for hemostatic purpose into the stent. A second 6F guiding catheter has been navigated into the right ICA to allow the occlusion with coils (black arrow) of the petrous portion of the right ICA.

View larger version (118K): [in a new window]   FIG 5. Left ICA angiogram during the occlusion of the right ICA, showing good cross-flow through the anterior communicating artery.

View larger version (118K): [in a new window]   FIG 6. Right common carotid unsubtracted angiogram (lateral projection) after the removal of the balloon, showing the persisting occlusion of the right ICA (arrow).