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STENTING OF CAROTID ARTERY FALSE ANEURYSMS
Clinical Radiology (2003) 58: 176±177 doi:10.1053/crad.2002.1125, available online at www.sciencedirect.com
Correspondence Letters are published at the discretion of the Editor. Opinions expressed by correspondents are not necessarily those of the Editor. Unduly long letters may be returned to the authors for shortening. Letters in response to a paper may be sent to the author of the paper so that the reply can be published in the same issue. Letters should be typed double spaced and should be signed by all authors personally. References should be given in the style specified in the Instructions to Authors at the back of the Journal.
STENTING OF CAROTID ARTERY FALSE ANEURYSMS SIR We read with interest the case report by Patel J et al. [1] on the treatment of a carotid artery false aneurysm with a covered stent. We have recently had a similar case of a 36-year-old man who presented to the emergency department following a stab injury to the left side of his neck. Angiography demonstrated a large false aneurysm arising from the right common carotid artery (CCA) with an associated ®stula to the internal jugular vein (IJV) at this level (Fig. 1a). Flow within
the carotid artery distal to the false aneurysm (Fig. 1b) was reversed ( ®lled via the intracranial circulation), and therefore ¯ow from the intracranial circulation was contributing to the false aneurysm and arterio±venous ®stula. Furthermore, selective angiography demonstrated contributions to the false aneurysm/arteriovenous ®stula from branches of the thyrocervical trunk and external carotid artery (Fig. 2). After crossing the tear in the CCA with a guidewire, a covered 10 mm by 5 cm endovascular stent (Wallgraft, Boston Scienti®c, Minneapolis, MN, U.S.A.) was then placed across the defect with its proximal end at the origin of the common carotid and its distal end just short of the bifurcation. The bleeding from the branches of the thyrocervical trunk
Fig. 1 ± (a) Injection of the right CCA shows rapid ®lling of the false aneurysm (arrows) and internal jugular vein (arrow heads) via the arterio± venous ®stula. More delayed image (b) shows contrast medium within the internal and external carotid arteries distal to the false aneurysm (curved arrows).
0009-9260/03/$30.00/0
# 2003 Published by Elsevier Science Ltd on behalf of The Royal College of Radiologists
177
CORRESPONDENCE
Fig. 2 ± Contributions to the false aneurysm from branches of the thyrocervical trunk. and external carotid artery were treated with selective catheterization and coil embolization. Completion angiography (Fig. 3) showed a good stent position within the right CCA with no ®lling of the false aneurysm or IJV from either the CCA itself, the thyrocervical trunk or branches of the external carotid artery. The patient was asymptomatic and had normal ¯ow demonstrated in his carotid artery on ultrasound at follow-up 3 months later. We would therefore agree with the authors that covered stenting of false aneurysms arising from the CCA would appear to be a robust technique. Furthermore it can also be used in more complicated cases such as ours where there was an associated arterio±venous ®stula, and in combination with embolization of smaller feeding vessels. D. W. RAMSAY W. McAULIFFE
Fig. 3 ± Stent position within the CCA and no ®lling of the IJV or false aneurysm.
REFERENCES 1 Patel JV, Rossbach MM, Cleveland TJ, Gaines PA, Beard JD. Endovascular stent-graft repair of traumatic carotid artery pseudoaneurysm. Clin Radiol 2002;57:308±311.
Correspondence Letters are published at the discretion of the Editor. Opinions expressed by correspondents are not necessarily those of the Editor. Unduly long letters may be returned to the authors for shortening. Letters in response to a paper may be sent to the author of the paper so that the reply can be published in the same issue. Letters should be typed double spaced and should be signed by all authors personally. References should be given in the style specified in the Instructions to Authors at the back of the Journal.
STENTING OF CAROTID ARTERY FALSE ANEURYSMS SIR We read with interest the case report by Patel J et al. [1] on the treatment of a carotid artery false aneurysm with a covered stent. We have recently had a similar case of a 36-year-old man who presented to the emergency department following a stab injury to the left side of his neck. Angiography demonstrated a large false aneurysm arising from the right common carotid artery (CCA) with an associated ®stula to the internal jugular vein (IJV) at this level (Fig. 1a). Flow within
the carotid artery distal to the false aneurysm (Fig. 1b) was reversed ( ®lled via the intracranial circulation), and therefore ¯ow from the intracranial circulation was contributing to the false aneurysm and arterio±venous ®stula. Furthermore, selective angiography demonstrated contributions to the false aneurysm/arteriovenous ®stula from branches of the thyrocervical trunk and external carotid artery (Fig. 2). After crossing the tear in the CCA with a guidewire, a covered 10 mm by 5 cm endovascular stent (Wallgraft, Boston Scienti®c, Minneapolis, MN, U.S.A.) was then placed across the defect with its proximal end at the origin of the common carotid and its distal end just short of the bifurcation. The bleeding from the branches of the thyrocervical trunk
Fig. 1 ± (a) Injection of the right CCA shows rapid ®lling of the false aneurysm (arrows) and internal jugular vein (arrow heads) via the arterio± venous ®stula. More delayed image (b) shows contrast medium within the internal and external carotid arteries distal to the false aneurysm (curved arrows).
0009-9260/03/$30.00/0
# 2003 Published by Elsevier Science Ltd on behalf of The Royal College of Radiologists
177
CORRESPONDENCE
Fig. 2 ± Contributions to the false aneurysm from branches of the thyrocervical trunk. and external carotid artery were treated with selective catheterization and coil embolization. Completion angiography (Fig. 3) showed a good stent position within the right CCA with no ®lling of the false aneurysm or IJV from either the CCA itself, the thyrocervical trunk or branches of the external carotid artery. The patient was asymptomatic and had normal ¯ow demonstrated in his carotid artery on ultrasound at follow-up 3 months later. We would therefore agree with the authors that covered stenting of false aneurysms arising from the CCA would appear to be a robust technique. Furthermore it can also be used in more complicated cases such as ours where there was an associated arterio±venous ®stula, and in combination with embolization of smaller feeding vessels. D. W. RAMSAY W. McAULIFFE
Fig. 3 ± Stent position within the CCA and no ®lling of the IJV or false aneurysm.
REFERENCES 1 Patel JV, Rossbach MM, Cleveland TJ, Gaines PA, Beard JD. Endovascular stent-graft repair of traumatic carotid artery pseudoaneurysm. Clin Radiol 2002;57:308±311.