J Cerebrovasc Endovasc Neurosurg.  2020 Dec;22(4):211-215. 10.7461/jcen.2020.E2019.11.001.

Endovascular management of intracranial pseudoaneurysm: an institutional experience

• Phogat V
• Gandhi A
• Srivastava T
• Mishva K

• KMID: 2511034
• DOI: http://doi.org/10.7461/jcen.2020.E2019.11.001

Abstract

Objective
Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) and vertebral artery are rare entities but with varied treatment options. PSAs can be spontaneous or secondary to trauma, infections, malignancies or iatrogenic. To find out the efficacy of various endovascular interventions in the management of ICA and vertebral PSAs.
Methods
The study included 14 patients diagnosed with intracranial PSAs who underwent endovascular interventions in SMS Medical College, Jaipur (Rajasthan) between June 2015 to January 2019. The clinical and radiological findings (computed tomography angiography and digital subtraction angiography) were reviewed and the consequent endovascular intervention carried out and their results were analyzed.
Results
Total 14 patients were studied out of which 8 (57.1%) were anterior circulation PSAs and 6 (42.9%) were posterior circulation PSAs There were 10 (71.4%) females and 4 (28.5%) males between the age of 9 to 65 years. Only 2 patients with PSA had past history of trauma. Coiling was done in 8 patients (57.1%), stenting in 2 patients (14.2%), parent artery occlusion in 1 patient (7.1%), glue embolization in 1 patient (7.1%) while coiling with glue in 1 patient (7.1%) and flow diverter in 2 patients (14.2%). Immediate and complete occlusion was achieved in 11 (78.6%) patients while 3 (21.4%) patients had subtotal occlusion. 11 patients under follow up till June 2019 did not report recurrence or new neurological deficit.
Conclusions
Endovascular interventions is minimally invasive and safe treatment strategy for intracranial PSAs. The ultimate choice of technique depends on clinical and imaging characteristics.

Keyword

Pseudoaneurysm; Endovascular; Coiling; Glue embolization; Traumatic

Figure

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  Fig. 1. (A) Left vertebral artery pseudoaneurysm. (B) Left vertebral artery angiogram, post coiling.

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  Fig. 2. (A) Angiogram showing Distal anterior cerebral artery pseudoaneurysm. (B) Pseudoaneurysm with glue cast. (C) Post embolization DSA. DSA, digital subtraction angiography.

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  Fig. 3. (A) Pseudoaneurysm in anterior cerebral artery. (B) Angiography post flow diverter insertion.

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