Successful treatment of a traumatic carotid pseudoaneurysm with the Pipeline stent: Case report and review of the literature
The patient is a 64-year-old female initially admitted with left-sided chronic maxillary, ethmoidal, and sphenoidal sinusitis. She underwent endoscopic left ethmoidectomy, maxillary antrostomy, and sphenoidostomy. During dissection of the sphenoid mucosa, pulsatile bleeding was observed through a punctate hole in the carotid canal, raising concern for injury to the internal carotid artery. Hemostasis was achieved with an Afrin-soaked pledget and pressure. The patient awoke neurologically intact and an immediate postoperative computed tomography angiogram (CTA) showed no evidence of contrast extravasation or pseudoaneurysm [].\nA CTA repeated one week later, revealed a 2 × 1.4 mm pseudoaneurysm arising from the left internal carotid artery at the level of the carotid canal dehiscence []. Angiography confirmed the presence of the pseudoaneurysm, [] and she passed a test balloon occlusion with hypotensive challenge []. The patient was counseled in regard to both deconstructive treatment options and vessel preservation with the Pipeline stent. Ultimately, the patient was loaded with 600 mg of Plavix and 325 mg of aspirin. At the time of treatment, the pseudoaneurysm had enlarged to 2.8 mm []. A 4 × 16 mm Pipeline stent was deployed across the pseudoaneurysm and the control angiogram demonstrated contrast stasis within the aneurysmal dome []. A 4 × 14 mm Pipeline stent was placed within the first stent to reinforce the construct and the final control angiogram revealed further stasis []. Four-month follow-up angiogram showed complete obliteration of the pseudoaneurysm and successful reconstruction of the left internal carotid lumen []. The patient has remained neurologically intact and has been maintained on daily aspirin 81 mg and Plavix 75 mg. The Plavix was stopped at 6 months and no significant epistaxis was encountered in the postoperative period.