Emergency endovascular stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery.
BACKGROUND
An internal carotid artery (ICA) injury is an uncommon but potentially fatal complication of transsphenoidal surgery.


METHODS
We report a 61-year-old male patient with a right cavernous ICA injury sustained during transsphenoidal surgery and who underwent endovascular Stent graft placement. The ICA trapping was not indicated because of the absence of the left A1 on preoperative magnetic resonance angiography. During Stent graft placement, the ICA wall could not be completely fit with a stent due to its stiff nature and the carotid curve. The gap between the stent and the ICA wall was filled using a coiling procedure on the first postoperative day.


CONCLUSIONS
Endovascular Stent graft placement for posttranssphenoidal carotid artery injury is a useful technical adjunct to the management strategy and has the potential to minimize the risk of having to sacrifice the ICA. In cases of incomplete reconstruction of the Stent graft placement due to its stiff nature and the carotid curve, an additional coiling procedure could be helpful to obliterate the gap between the stent and the ICA wall. To avoid carotid injury during transsphenoidal surgery, careful preoperative evaluation of vascular structures and meticulous surgical technique are necessary.
Park
Young Seok
YS
Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
Jung
Jin Young
JY
Ahn
Jung Yong
JY
Kim
Dong Jun
DJ
Kim
Sun Ho
SH
D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D020212:Carotid Artery Injuries / Q000175:diagnosis / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004630:Emergencies; D006801:Humans; D007049:Iatrogenic Disease; D021621:Imaging, Three-Dimensional; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D013101:Sphenoid Sinus / Q000601:surgery; D015607:Stents