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Objective:
Carotid artery pseudo-aneurysms are traditionally treated surgically however open surgical repairs are associated with a high rate of morbidity and mortality. In recent years various endovascular techniques have evolved to treat PSA in this location. We review the literature pertaining to the use of covered stents to manage non-infected, extracranial carotid artery PSA sustained iatrogencially or from trauma.
Method:
An extensive review of the literature using Ovid, PubMed and Google Scholar was performed. All published cases in the English language since 1997 were identified using the following keywords: “pseudoaneurysm,” “carotid,” “endovascular repair,” and “stent.” Studies that involved a hybrid procedure, involving a combination of open and endovascular approaches, bare metal stents, or coiling and stent placement were excluded.
Results:
Eighty-two cases of post traumatic or post procedural carotid artery PSA treated with a covered stent were identified. These patients ranged in age from 12 to 87 years old, and 62.2% were male. Fifty-one percent of pseudo-aneurysms identified were iatrogenic (42), 13.4% were after blunt trauma (11) and 35.4% were after penetrating injury (29). Post-procedural follow-up ranged from 5 days to 108 months. There was an overall complication rate of 33% (27/82). Sixteen complications occurred within the first 24 hours. Perioperative myocardial infarction and cerebrovascular events occurred in 9.8% of patients. Mortality in this series was 3.7% (3). Other complications included endoleak (3, 3.7%), hematoma (1, 1.2%) and intimal flap (1, 1.2%). Pseudo-aneurysm persisted in 3.7% (3), significant stenosis occurred in 3.7% (3) and complete occlusion of the stent occurred in 6.1% (5).
Conclusion:
Endovascular placement of a covered stent for the treatment of carotid PSA has been shown to be effective and it carries a similar risk to an open repair. An endovascular approach should be considered when treating carotid artery pseudo-aneurysms.