How should I treat concomitant post-endarterectomy carotid pseudoaneurysm and contralateral symptomatic stenosis?
Umberto Marcello Bracale1, Massimo Porcellini, Giancarlo Bracale
1University Federico II of Naples, Department of Vascular and Endovascular Surgery, Naples, Italy. palumbe@tin.it
Insights
A 74-year-old male experienced crescendo transient ischemic attacks (TIAs) due to an internal carotid artery (ICA) pseudoaneurysm. Treatment involved surgical repair or endovascular procedures for the pseudoaneurysm.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Diagnostic Imaging
Background:
- A 74-year-old male presented with crescendo transient ischemic attacks (TIAs), a serious warning sign of impending stroke.
- The patient had a history of hypertension and hyperlipidemia, common risk factors for cardiovascular disease.
Observation:
- Diagnostic investigations included duplex ultrasound and MR angiography to visualize the cerebral vasculature.
- These imaging studies identified a pseudoaneurysm originating from the internal carotid artery (ICA).
Findings:
- The pseudoaneurysm of the ICA was diagnosed as the cause of the patient's crescendo TIAs.
- Crescendo TIAs indicate a high risk of major stroke if left untreated.
Implications:
- Treatment options for ICA pseudoaneurysm include open surgical repair or endovascular procedures.
- Surgical intervention aims to prevent stroke by addressing the source of emboli or hemodynamic instability.
- Prompt diagnosis and management are crucial for improving outcomes in patients with carotid artery pseudoaneurysms.
Abstract
Background:
A 74-year-old male patient complaining of crescendo TIAs, hypertension and hyperlipidaemia.
Investigation:
Duplex ultrasound scan MR angiography.
Diagnosis:
Pseudoaneurysm stemming from the ICA.
Treatment:
An open or endovascular procedure for the right pECCA repair, or a left CEA or CAS.
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