Yonsei Med J.  2012 Jan;53(1):224-227. 10.3349/ymj.2012.53.1.224.

Treatment of an Acute Mycotic Aneurysm of the Common Carotid Artery with a Covered Stent-Graft

• Lee SH
• Cho YK
• Park JM
• Chung C
• Kim HS
• Woo JJ

• KMID: 1779711
• DOI: http://doi.org/10.3349/ymj.2012.53.1.224

Abstract

We report herein a case successful endovascular treatment with a stent-graft of a rare case of rapidly growing mycotic aneurysm of the left common carotid artery due to acute bacterial endocarditis after eradication of the infection. Infected mycotic aneurysms of the peripheral vasculature have been considered as a contraindication for stent-graft implantation because of the possibility of microorganism spreading to the stent-graft; however, if there is evidence of complete eradication of microorganism and surgery is not an option, stent-graft implantation can be an effective and safe treatment modality for exclusion of the mycotic aneurysm.

Keyword

Mycotic aneurysm; covered stent; endovascular therapy; infective endocarditis; carotid artery

MeSH Terms

Acute Disease
Aged, 80 and over
Aneurysm, Infected/etiology/radiography/*therapy
Angioplasty/*methods
Carotid Artery Diseases/etiology/radiography/*therapy
Endocarditis, Bacterial/*complications/radiography
Female
Humans
*Stents
Treatment Outcome

Figure

• 

  Fig. 1 Bacterial endocarditis and mycotic aneurysm of the left common carotid artery in an 87-year-old woman with acute cerebral infarction. (A) Transfemoral cerebral angiography showing focal severe stenosis (up to 75%) of the proximal left ICA (arrow) and transient vascular spasm in the petrous ICA (arrowheads). (B) Thoracic aortography showing no evidence of stenosis or aneurysm of the proximal common carotid artery. (C) Echocardiography showing a newly visible 6×5 mm valvular vegetation of the non-coronary cusp of the aortic valve (arrow), which was not present in preprocedural echocardiography. (D) Chest CT 26 days after admission showing an incidental 22 mm×20 mm saccular aneurysm 2 cm distal to the origin of the left CCA (arrow). (E) Thoracic aortography three days after chest CT showing a saccular aneurysm in the proximal left CCA (arrow) with mass effect to the lumen of the adjacent proximal CCA (arrowhead). (F) The roadmap image of the left common carotid artery during stent insertion showing proper advancement of an undeployed 10 mm×5 cm polytetrafluoroethylene covered stent-graft across the wide neck of the aneurysm in the proximal left common carotid artery (arrows). (G) The final thoracic aortography after stent-graft implantation revealing complete exclusion of the aneurysm and a widely patent implanted stent-graft (arrows). (H) Follow-up chest CT 12 months after the procedure showing a completely excluded aneurysm, thrombosis within the aneurismal lumen (arrow), and a widely patent stent-graft (arrowheads). ICA, internal carotid artery; CT, computed tomography; CCA, common carotid artery.

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