Cases reported "Carotid Artery Diseases"

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1/258. Treatment of symptomatic cervical carotid dissections with endovascular stents.

    OBJECTIVE: Symptomatic dissections of the cervical carotid artery (CCA) can be spontaneous or secondary to trauma and may be associated with pseudoaneurysms. Surgical treatment is often difficult or unavailable. We report the successful use of endovascular stents in the treatment of symptomatic dissection of the CCA. methods: Five consecutive patients with symptomatic CCA dissection were seen at our institution. There were four female patients and one male patient, ranging in age from 19 to 56 years. One dissection was spontaneous. The others were secondary to a gunshot wound (one patient), blunt neck trauma (two patients), and endovascular treatment of atherosclerotic carotid bifurcation disease (one patient). Balloon-expandable and self-expanding stents were placed via a transfemoral approach. RESULTS: Success in restoring the carotid lumen with two to five stents in each patient was angiographically demonstrated. There were no procedure-related complications. All patients experienced significant clinical improvement within the first 24 hours and complete long-term recovery. CONCLUSION: Symptomatic dissections of the CCA can be successfully treated by using endovascular stents.
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2/258. Treatment of an intracranial aneurysm using a new three-dimensional-shape Guglielmi detachable coil: technical case report.

    OBJECTIVE AND IMPORTANCE: Coil embolization of wide-necked aneurysms is currently difficult, when using a conventional endovascular approach without resorting to complex adjunctive techniques. CLINICAL PRESENTATION: A 41-year-old woman with a history of systemic lupus erythematosus and hypertension refractory to treatment presented with an unruptured right ophthalmic segment aneurysm of the internal carotid artery having an unfavorable neck-to-fundus ratio. INTERVENTION: A new type of Guglielmi detachable coil (Target therapeutics, Fremont, CA), consisting of a series of omega loops, spontaneously forms a three-dimensional cage after deployment and was used to successfully treat the aneurysm, which was angiographically stable at the 3-month follow-up. CONCLUSION: The new Guglielmi detachable coil may be useful in the embolization of aneurysms having an unfavorable geometry, which would otherwise not be amenable to endovascular treatment without adjunctive techniques.
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3/258. Inflammatory pseudotumor of carotid artery: a case report.

    Inflammatory pseudotumor is an uncommon round and spindle cell proliferative lesion of unknown etiology that occurs most commonly in the lung. But it also occurs in diverse extrapulmonary locations such as the abdomen, retroperitoneum, pelvis, heart, head and neck, upper respiratory tract, trunk, bladder and extremities. The extrapulmonary inflammatory pseudotumor is often larger, less well circumscribed and multinodular. Proximity of the tumor to vital structures or involvement of vital organs compromises the opportunity for complete resection, thus higher recurrence rates are often reported even after surgical treatment. The authors report a case of inflammatory pseudotumor originating from the common carotid artery in a 42-year-old female patient with a rapidly growing neck mass, treated by en-bloc resection of inflammatory pseudotumor and a long segment of common carotid artery followed by PTFE graft interposition.
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4/258. Endovascular stent placement for cervical internal carotid artery aneurysm causing cerebral embolism: usefulness of neuroradiological evaluation.

    We present a case of a cervical internal carotid artery aneurysm that caused cerebral embolism. This lesion was supposed to be a dissecting aneurysm due to blunt neck injury. The large aneurysm with intramural thrombus was treated with endovascular placement of a balloon-expandable stent. Both CT and MRI were useful for evaluating the size and characteristics of the aneurysmal wall. Intravascular ultrasound imaging was also useful for evaluation of the satisfactory stent deployment and identification of the neck of the aneurysm. We discuss effectiveness of endovascular stenting for cervical internal carotid artery aneurysm with intramural thrombus and the usefulness of a combination of the neuroradiological imaging before, during and after the interventional procedure.
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5/258. Curved planar reformatted CT angiography: usefulness for the evaluation of aneurysms at the carotid siphon.

    BACKGROUND AND PURPOSE: Three-dimensional CT angiography uses the data obtained on a contrast-enhanced CT brain scan to generate 3D images of the intracranial vasculature. We describe the methodology of curved planar reformatting (CPR) for CT angiography and characterize its usefulness in the evaluation of aneurysms at the carotid siphon, comparing it with the shaded surface display technique (SSD). methods: Eighty-seven patients with suspected intracranial aneurysms at CT angiography were examined by conventional cerebral angiography, and the patients with aneurysm(s) at the carotid siphon were selected for study. For these patients, the visibility of the neck and fundus of the aneurysms on CT angiograms was compared for those obtained with SSD and those with CPR, and observer reproducibility was evaluated with the kappa statistic. RESULTS: Eighteen patients were confirmed to have an aneurysm at the carotid siphon on conventional angiograms. Seventeen aneurysms were depicted at CT angiography with SSD; 18 aneurysms with CPR. The number of visible aneurysmal necks and fundi was nine and 12, respectively, with SSD; 18 and 18, respectively, with CPR. CONCLUSION: CPR allows better demonstration of the body and neck of an aneurysm at the carotid siphon, which has a tortuous course and is surrounded by complex bony structures. CPR may be a useful adjunct for the evaluation of aneurysms in this region.
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ranking = 3
keywords = neck
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6/258. The use of an external-internal shunt in the treatment of extracranial internal carotid artery saccular aneurysms: technical case report.

    BACKGROUND: Extracranial internal carotid artery aneurysms (EICAA) are rare lesions. Resection and grafting is the preferred method of management. However, the details of shunt use in surgery for this type of aneurysm has been described in few articles. We describe an external-internal shunt with intra-aneurysmal trans-orifice insertion. CASE REPORT: A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram showed a saccular EICAA involving the ICA distal to the bifurcation, with kinking of the internal carotid artery (ICA). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm. RESULTS: Using the shunt technique, we successfully removed the aneurysm and reconstructed the ICA. The end-to-end anastomosis was easy because the shunt was involved only in the distal free end of the ICA, but not in the proximal free end of the ICA. CONCLUSION: This technique could be an option for the treatment of EICCA when a shunt is needed to maintain the cerebral circulation.
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7/258. Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child. Case report.

    Pseudoaneurysm formation of the cervical internal carotid artery (ICA) is a rare, potentially lethal complication of deep neck space infection. This entity typically occurs following otolaryngological or upper respiratory tract infection. The pseudoaneurysm is heralded by a pulsatile neck mass, Homer's syndrome, lower cranial neuropathies, and/or hemorrhage that may be massive. The recommended treatment includes prompt arterial ligation. The authors present a case of pseudoaneurysm of the cervical ICA complicating a deep neck space infection. A parapharyngeal Staphylococcus aureus abscess developed in a previously healthy 6-year-old girl after she experienced pharyngitis. The abscess was drained via an intraoral approach. On postoperative Day 3, the patient developed a pulsatile neck mass, lethargy, ipsilateral Horner's syndrome, and hemoptysis, which resulted in hemorrhagic shock. Treatment included emergency endovascular occlusion of the cervical ICA and postembolization antibiotic treatment for 6 weeks. The patient has made an uneventful recovery as of her 18-month follow-up evaluation. Conclusions drawn.from this experience and a review of the literature include the following: 1) mycotic pseudoaneurysms of the carotid arteries have a typical clinical presentation that should enable timely recognition; 2) these lesions occur more commonly in children than in adults; 3) angiography with a view to performing endovascular occlusion should be undertaken promptly; and 4) endovascular occlusion of the pseudoaneurysm is a viable treatment option.
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8/258. Tracheocarotid artery fistula infected with methicillin-resistant staphylococcus aureus.

    Massive life-threatening haemorrhage from a fistula between the trachea and a major blood vessel of the neck is a rare complication of the tracheostomy procedure, well-recognized by anaesthetists and otolaryngologists. Although the lesion is likely to be encountered at autopsy, it is not described in histopathological literature. The possible causes are discussed together with the macroscopic and microscopic appearances of the lesion. Suitable procedures for its identification and for obtaining appropriate histopathological blocks are suggested. Presence of methicillin-resistant staphylococcus aureus (MRSA) has not been documented before and might have contributed to the genesis of the fistula in this case.
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keywords = neck
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9/258. Dural waisting as a sign of subarachnoid extension of cavernous carotid aneurysms: a follow-up case report.

    OBJECTIVE: Even when augmented by CT and MRI, it can be difficult on angiography to predict which intracavernous carotid artery aneurysms (ICCAA) have subarachnoid extension and therefore pose a higher risk of subarachnoid hemorrhage. Previously we reported a case of an ICCAA, which on angiogram had a focal tapering of the dome that we termed a "waist." At surgery this lesion was found to have subarachnoid extension. We postulated that this dural "waisting" on the arteriogram was a predictor of subarachnoid extension. Herein we report a second case of an ICCAA with the angiographic appearance of a waist that was also confirmed to have subarachnoid extension at surgery, thereby strengthening our original hypothesis. CLINICAL PRESENTATION: A 40-year-old woman presented with a 3-month history of bitemporal headache, diplopia, and a left sixth nerve palsy. MRI showed a lesion in the vicinity of the left cavernous carotid sinus and an arteriogram confirmed the presence of a large cavernous carotid aneurysm. As in the previous case, the aneurysm fundus was indented, creating a waist on the aneurysm dome. INTERVENTION: After passing a trial balloon occlusion of the involved carotid artery, the patient was brought to the operating room for lesion trapping. The aneurysm fundus was seen to extend beyond the falciform ligament and with subsequent dissection, the neck of the aneurysm was seen to incorporate the carotid artery distal to the ophthalmic artery. The aneurysm was trapped by ligating the internal carotid artery in the neck and by placing a clip on the intracranial carotid proximal to the posterior communicating artery. CONCLUSION: The presence of subarachnoid extension of an ICCAA can be difficult to elucidate on an arteriogram. This is an additional case in which a focal narrowing or "waisting" of the aneurysm dome seen on an angiogram served as a marker of subarachnoid extension.
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10/258. Endovascular treatment of a ruptured paraclinoid aneurysm of the carotid syphon achieved using endovascular stent and endosaccular coil placement.

    We herein report a case of a ruptured superior hypophyseal aneurysm of the left supraclinoid carotid artery that could not be treated with a Guglielmi detachable coil (GDC), even in combination with a supporting nondetachable balloon. After an unsuccessful attempt at surgical clipping, treatment consisted of the placement of a stent over the neck of the aneurysm, advancement of a microcatheter through the stent mesh, and endosaccular embolization with a GDC. The late clinical outcome was excellent.
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