Nitinol Stenting in Post-Traumatic Pseudo-Aneurysm of Internal Carotid Artery

Background: A pseudoaneurysm of the internal carotid artery (ICA) at its cervicl part, is a rare and often lethal complication after cervical trauma. The treatment of choice is anticoagulation. Patients with a contraindication for anticoagulation or those who do not improve with standard treatment, warrant either a surgical repair or stent placement. Stent placement posses both short and long term risks such as immediate ischemic events, in-stent stenosis and stent breakage, thus the choice of stent type is critical. Advances in stent technology have made cervical stent placement a viable option. We report our experience with the LEO + (Balt Extrusion, Montmorency, France) nitinol flexible self expanding stent for post-traumatic ICA aneurysms. Methods: 5 patients suffering a post-traumatic cervical ICA pseudo-aneurysms refractory to standard treatment were treated with nitinol braided flexible self expanding stent. This stent has a shape memory and superelasticity virtues making it suitable. Diagnosis was made with CT angiography and confirmed by catheter angiography. All procedures were preformed under local anesthesia. Time between trauma and treatment ranged six days to over five years. Follow-up was performed by CT angiography or conventional angiography. Results: Five patients, having eight aneurysms were treated using 12 stents. In all cases, appropriate stent placement was achieved. No immediate or late complications, as well as no neurological sequele reported at 6 months. Radiological follow-up exams demonstrated complete pseudoaneurysm closure. Conclusion: Stent placement can be a safe and definitive treatment option for patients to conventional medical treatment.