Article Figures & Data
Figures
- Fig 1.
Patient 11.
A, Lateral digital subtraction angiography (DSA) of a 40-year-old woman with an intimal flap within the distal cervical portion of the left internal carotid artery resulting in pseudoaneurysm (windsock deformity, asterisk) and 75% stenosis.
B, A 6 × 20 mm Smart stent (Cordis Corp.) was placed with no residual stenosis and improved anterograde flow (lateral projection). There was residual slow filling of the pseudoaneurysm (asterisk).
C, Follow-up angiography at 25 months revealed a widely patent stent with no filling of the pseudoaneurysm (lateral projection).
- Fig 2.
Patient 19.
A, Lateral DSA of a 19-year-old man with a traumatic pseudoaneurysm arising from the left internal carotid artery at the level of the mid-C2 vertebral body. There was a long segment of dissection flap (arrows) from the pseudoaneurysm (asterisk) to the level of the cavernous internal carotid artery.
B, Road-mapping guidance was used to select the true lumen with a 0.018-inch Roadrunner guidewire (Cook Inc.). A 9 × 30 mm Precise stent (Cordis Corp.) was placed across the neck of the pseudoaneurysm (asterisk), which resulted in slower flow within the pseudoaneurysm (lateral projection).
C, Follow-up angiography at 6.2 months showed normal caliber at the site of injury with healing of the pseudoaneurysm and dissection flap (lateral projection).
- Fig 3.
Patient 18.
A, Oblique frontal DSA of a 22-year-old man with a traumatic dissection with flow-limiting stenosis and a large pseudoaneurysm (asterisks) of the upper cervical right internal carotid artery near the skull base.
B, A 7 × 30 mm Precise stent (Cordis Corp.) was placed with reversal of the associated stenosis (lateral projection). The pseudoaneurysm associated with the dissection, aside from stent placement, was also treated by coil embolization with a reduction in its size; however, the tear in the internal carotid artery at this level was large and the pseudoaneurysm partially filled.
C, There was an interval increase in the size of the pseudoaneurysm with coil compaction at 19 days (lateral projection). The pseudoaneurysm was retreated by placement of additional coils and deployment of a second 7 × 30 mm Precise stent (Cordis Corp.) across the pseudoaneurysm neck, which resulted in near-total obliteration. The internal carotid artery flow remained normal and the true lumen fully patent and clear of thrombus.
Tables
Patient No./Age (y)/Sex Symptomatic Vessel Etiology of Dissection 1/66/M No RCCA Iatrogenic 2/51/M TIA RICA Iatrogenic 3/43/F No RICA Spontaneous 4/36/F CN palsy LICA Trauma 5/43/M No LICA Spontaneous 6/56/M TIA RICA Spontaneous (FMD) 7/56/F Stroke LCCA Iatrogenic 8/45/F No RICA Spontaneous 9/76/F CN palsy LICA Spontaneous 10/47/M No LICA Iatrogenic 11/40/F No LICA Spontaneous 12/34/F Stroke LICA Trauma 13/45/F Stroke RICA Spontaneous (FMD) 14/44/M No RCCA Iatrogenic 15/52/M TIA LCCA Iatrogenic 16/35/F TIA RICA Trauma 17/81/F No LICA Spontaneous 18/22/M No RICA, LCCA Trauma 19/19/M No LICA Trauma 20/60/M TIA LICA Trauma 21/42M TIA LICA Trauma 22/51/M No LICA Trauma 23/52/M Horner syndrome LICA Trauma 24/66/M No RCCA Iatrogenic 25/46/M TIA RICA Iatrogenic 26/72/F Stroke LCCA Iatrogenic Note.—TIA indicates transient ischemic attack; CN, cranial nerve; R, right; L, left; ICA, internal carotid artery; CCA, common carotid artery; FMD, fibromuscular dysplasia.
Patient No. Prestent Stenosis (%) Poststent Stenosis (%) Pseudo-aneurysm Stent Size (mm) 1 80 0 No Wallstent 10 × 42 2 70 0 No Wallstent 10 × 20 3 75 0 1 Wallstent 5 × 20 4 60 0 1 Wallstent 5 × 20 5 95 0 No Wallstent 6 × 20 6 95 0 1 Wallstent 8 × 20 7 60 0 No Wallstent 10 × 42 8 50 0 1 Smart 10 × 40 9 60 No intervention 1 N/A N/A 10 60 0 1 Smart 6 × 20 11 75 0 1 Smart 6 × 20 12 60 0 1 Smart 7 × 20 13 80 0 No Angioplasty only N/A 14 0 0 1 Smart 10 × 20 15 85 0 No Smart 9 × 30 16 50 0 2 Precise 6 × 40 17 0 0 1 Precise 6 × 30 18: 1st RICA 0 0 1 Precise 7 × 30 18: 1st LCCA 0 0 1 Smart 12 × 40 18: 2nd RICA 0 0 1 Precise 7 × 30 18: 2nd LCCA 0 0 1 Smart, 12 × 40, Smart 12 × 40 19 90 0 1 Precise 9 × 30 20 70 50 No Precise 6 × 40 21 99 0 1 Precise 7 × 40 22 65 0 1 Precise 7 × 40 23 25 0 1 Precise 8 × 40 24 90 0 No Precise 9 × 20 25 0 0 1 Precise 9 × 40 26 0 0 2 Precise 7 × 30 Note.—R indicates right; L, left; ICA, internal carotid artery; CCA, common carotid artery; N/A, not applicable; Wallstent (Boston Scientific, Natick, MA); Smart, Precise (Cordis, Miami Lakes, FL).
Patient No. Procedural Long-term Imaging Follow-up (mo) Clinical Follow-up (mo) 1 No Deceased post-MI 0.3 2 No Recurrent TIA Angiography (12) 12 3 No No 48.2 4 No Asymptomatic ipsilateral occlusion Angiography (3.4) 3.4 5 No Ipsilateral occlusion, contralateral stroke Angiography (0.7) 0.7 6 No Contralateral CEA, stroke Angiography (7.4) 7.4 7 No No 1.3 8 No No Angiography (2.1) 2.1 9 New intimal flap No 19.0 10 No No CT (41.5) 41.5 11 No No Angiography (25.0) 25.0 12 Decreased distal pulses No 28.0 13 TIA No Angiography (40.1) 40.1 14 No No CT (18.4) 18.5 15 No No US (24.4) 24.4 16 No Recurrent TIA Angiography (2.7) 2.7 17 No Deceased post-MI CT (15.2) 15.2 18: 1st RICA No No Angiography (10.8) 16.0 18: 1st LCCA No No Angiography (10.8) 16.0 18: 2nd RICA TIA No Angiography (10.2) 15.4 18: 2nd LCCA No No Angiography (10.2) 15.4 19 No No Angiography (6.2) 23.9 20 TIA No Angiography (11.2) 11.2 21 No No Angiography (6.4) 13.4 22 No No 5.3 23 No No Angiography (5.6) 9.5 24 No No 7.0 25 No No 1.6 26 No No 0.2 Note.—R indicates right; L, left; ICA, internal carotid artery; CCA, common carotid artery; TIA, transient ischemic attack; MI, myocardial infarction; CEA, carotid endarterectomy; CT, computed tomography; US, ultrasound.
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