Therapy of an Enormous Extracranial Carotid Artery Aneurysm with Covered Coronary Stent

Background: Extracranial carotid artery pseudoaneurysms can result from various factors, such as trauma, vascular anomalies, iatrogenic damage, or infection. Infectious pseudoaneurysms are a rare complication of cervical lymphadenitis, deep neck infection, pharyngeal abscess or retropharyngeal abscess. When left untreated, infectious carotid pseudoaneurysms can lead to severe complications, such as clot propagation, distal embolization and hemorrhage, and ultimately, death resulting in mortality rates up to 77%. To date and due to the rare incidence, no evidence-based treatment guidelines are published. In addition to antibiotic therapy, surgical and endovascular treatment options have been established.

Methods: We report a case of a 2-year-old boy with chronic cervical lymphadenopathy over 2 months with positive Bartonella serology. For further investigation of the lymphadenopathy, an elective lymphadenectomy was planned. During this procedure, a large aneurysmal bulge was noticed, which was inadvertently injured and subsequently repaired with a vascular suture. MR and CT angiography revealed a giant pseudoaneurysm of the left internal carotid artery (ICA), causing significant compression of the naso- and oropharynx. After interdisciplinary consultation with vascular surgeons, pediatric surgeons and neurosurgeons, surgical intervention was judged not possible due to its proximity to the skull base; hence ligation of the internal carotid artery was proposed. Based on our interventional experience and to maintain perfusion of the left ICA we opted for endovascular stenting. Implantation of a covered coronary stent (4.5 mm diameter, 15 mm length) system (Papyrus stent) was successfully performed with no perioperative neurologic or cardiopulmonary complications. Follow-up imaging 6 years after stent implantation showed moderate in-stent stenosis that was treated successfully with a percutaneous transluminal angioplasty and a diameter of 6 mm could be reached. As of today, the patient remains asymptomatic beside the residual mild Horner's syndrome.

Conclusion: Endovascular treatment of extracranial carotid artery pseudoaneurysms with covered coronary stent systems can be used as a safe and efficacious approach also in pediatric patients with excellent mid-term outcome.

Publication History

Article published online:
13 February 2024