Traumatic aneurysm of the supraclinoid internal carotid artery and an associated carotid-cavernous fistula: vascular reconstruction performed using intravascular implantation of stents and coils. Case report

J Neurosurg. 2004 Jan;100(1):115-9. doi: 10.3171/jns.2004.100.1.0115.

Abstract

This report documents the treatment of a traumatic aneurysm of the supraclinoid internal carotid artery (ICA) that was associated with a carotid-cavernous fistula (CCF), which appeared following closed head trauma. This life-threatening lesion, which is very rare, required aggressive management achieved using intravascular stents and coils. A 19-year-old man presented with severe traumatic intracerebral and subarachnoid hematoma after he had suffered a severe closed head injury in a motor vehicle accident. Cerebral angiography performed 11 days after the injury demonstrated a traumatic aneurysm and severe narrowing of the right supraclinoid ICA, which was consistent with a dissection-induced stenosis associated with a direct CCF. Both lesions were successfully obliterated with preservation of the parent artery by using stents in conjunction with coils. Follow-up angiography obtained 7 months postoperatively revealed persistent obliteration of the aneurysm and CCF as well as patency of the parent artery. The patient remained asymptomatic during the clinical follow-up period of 14 months. Endovascular treatment involving the use of a stent combined with coils appears to be a feasible, minimally invasive option for treatment of this hard-to-treat lesion.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Carotid Artery Injuries / diagnostic imaging
  • Carotid Artery Injuries / surgery*
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid Artery, Internal / surgery*
  • Carotid-Cavernous Sinus Fistula / diagnostic imaging
  • Carotid-Cavernous Sinus Fistula / surgery*
  • Cerebral Angiography
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery*
  • Male
  • Reconstructive Surgical Procedures
  • Stents*
  • Vascular Surgical Procedures