Angioplasty and Stenting in Carotid Dissection with or without Associated Pseudoaneurysm
Yasha Kadkhodayana,
David T. Jecka,
Christopher J. Morana,b,
Colin P. Derdeyna,b,c and
DeWitte T. Cross, IIIa,b
a Department of Interventional Neuroradiology, Mallinckrodt Institute of Radiology, St. Louis, MO
b Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
c Department of Neurology, Washington University School of Medicine, St. Louis, MO
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FIG 1. Patient 11.
A, Lateral digital subtraction angiography (DSA) of a 40-year-old woman with an intimal flap within the distal cervical portion of the left internal carotid artery resulting in pseudoaneurysm (windsock deformity, asterisk) and 75% stenosis.
B, A 6 x 20 mm Smart stent (Cordis Corp.) was placed with no residual stenosis and improved anterograde flow (lateral projection). There was residual slow filling of the pseudoaneurysm (asterisk).
C, Follow-up angiography at 25 months revealed a widely patent stent with no filling of the pseudoaneurysm (lateral projection).
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FIG 2. Patient 19.
A, Lateral DSA of a 19-year-old man with a traumatic pseudoaneurysm arising from the left internal carotid artery at the level of the mid-C2 vertebral body. There was a long segment of dissection flap (arrows) from the pseudoaneurysm (asterisk) to the level of the cavernous internal carotid artery.
B, Road-mapping guidance was used to select the true lumen with a 0.018-inch Roadrunner guidewire (Cook Inc.). A 9 x 30 mm Precise stent (Cordis Corp.) was placed across the neck of the pseudoaneurysm (asterisk), which resulted in slower flow within the pseudoaneurysm (lateral projection).
C, Follow-up angiography at 6.2 months showed normal caliber at the site of injury with healing of the pseudoaneurysm and dissection flap (lateral projection).
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FIG 3. Patient 18.
A, Oblique frontal DSA of a 22-year-old man with a traumatic dissection with flow-limiting stenosis and a large pseudoaneurysm (asterisks) of the upper cervical right internal carotid artery near the skull base.
B, A 7 x 30 mm Precise stent (Cordis Corp.) was placed with reversal of the associated stenosis (lateral projection). The pseudoaneurysm associated with the dissection, aside from stent placement, was also treated by coil embolization with a reduction in its size; however, the tear in the internal carotid artery at this level was large and the pseudoaneurysm partially filled.
C, There was an interval increase in the size of the pseudoaneurysm with coil compaction at 19 days (lateral projection). The pseudoaneurysm was retreated by placement of additional coils and deployment of a second 7 x 30 mm Precise stent (Cordis Corp.) across the pseudoaneurysm neck, which resulted in near-total obliteration. The internal carotid artery flow remained normal and the true lumen fully patent and clear of thrombus.
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