Covered stent-graft treatment of traumatic internal carotid artery pseudoaneurysms: a review.
OBJECTIVE
To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures.


METHODS
We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case.


RESULTS
We identified 20 patients with traumatic extracranial ICA pseudoaneurysms due to penetrating craniocervical injuries or skull base fractures who had been treated with covered stent-graft implantation. Many discrepancies have been ascertained regarding the anticoagulation therapy. In 3 patients the ICA was totally occluded in the follow-up period, giving an overall occlusion rate 15%. No serious complication was reported as a result of the endovascular procedure.


CONCLUSIONS
Preliminary results suggest that placement of stent-grafts is a safe and effective method of treating ICA traumatic pseudoaneurysms resulting from penetrating craniocervical injuries or skull base fractures. The immediate results are satisfactory when the procedure takes place with appropriate anticoagulation therapy. The periprocedural morbidity and mortality and the early patency are also acceptable. A surveillance program with appropriate interventions to manage restenosis may improve the long-term patency.
Maras
Dimitrios
D
Department of Vascular Surgery, The Red Cross Hospital of Athens, Athens, Greece.
Lioupis
Christos
C
Magoufis
George
G
Tsamopoulos
Nikolaos
N
Moulakakis
Konstantinos
K
Andrikopoulos
Vasilios
V
D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology; D020197:Head Injuries, Penetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011859:Radiography; D020205:Skull Fracture, Basilar / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D015607:Stents; D014654:Vascular Patency
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene