Internal carotid artery pseudoaneurysms: treatment with the Wallgraft endoprosthesis

To report several cases illustrating the feasibility and mid-term efficacy of deploying a self-expanding stent-graft to treat traumatic ruptures, pseudoaneurysms, and a spontaneous dissection of the internal carotid artery (ICA).

One patient suffered a stab wound and another developed a large pseudoaneurysm years after a gunshot to the neck. The third patient presented with a spontaneous rupture in the setting of fibromuscular dysplasia, and the final patient developed a pseudoaneurysm following carotid endarterectomy in an irradiated neck. All 4 patients were successfully treated with Wallgrafts deployed in the ICA using either an open carotid (first 3 cases) or percutaneous approach (fourth patient). There were no adverse neurological events. During a mean 16-month follow-up (range 6-24), duplex ultrasound and CT scanning found no evidence of restenosis, occlusion, or persistent perfusion of the pseudoaneurysm, which was noted to decrease in all cases.

The thin-walled fabric of the Wallgraft appears capable of completely excluding the pseudoaneurysm, resulting in decreased aneurysm size over time.