Endovascular repair of infected carotid pseudoaneurysm: A case report

BACKGROUND: Pseudoaneurysm (PA) of the carotid artery is a rare but life-threatening complication following carotid endarterectomy (CEA). Management of carotid PAs is challenging due to the increased risk of stroke and nerve injury in an infected and re-operative field. Open surgery has been the mainstay for this complicated pathology however some patients have characteristics which make an endovascular approach more advantageous. Yet endovascular intervention for infected fields is scrutinized and used as a last option. HISTORY AND TREATMENT PLAN: 72 year old female with history of basilar artery aneurysm embolization and right internal carotid artery occlusion presented with a left carotid pseudoaneurysm after a CEA 6 months prior. She presented with 2 days of increasing left neck swelling, erythema, and a small ulcerated area with bloody discharge from incision site. A Computed Tomagraphy scan (CTA) showed hematoma surrounding the left ICA concerning for PA. Wound cultures were obtained which grew coagulase (-) staphylococcus. We elected to perform an endovascular procedure to temporize the bleeding by placing a stent graft (7 mm × 7.5 cm Gore Viabahn) across the left ICA. She remains asymptomatic with no recurrent symptoms 6 months postoperatively. CONCLUSION: Our experience in this patient indicates that endovascular stenting could be feasible and potentially effective intervention for infection-associated post-CEA PA in patients with an excessively high risk for stroke and nerve injury. We suggest each patient should be evaluated individually and all pertinent characteristics should be considered to make the best decision.