Emergency endovascular stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery

Surg Neurol. 2009 Dec;72(6):741-6. doi: 10.1016/j.surneu.2009.05.003. Epub 2009 Jul 14.


Background: An internal carotid artery (ICA) injury is an uncommon but potentially fatal complication of transsphenoidal surgery.

Case description: We report a 61-year-old male patient with a right cavernous ICA injury sustained during transsphenoidal surgery and who underwent endovascular Stent graft placement. The ICA trapping was not indicated because of the absence of the left A1 on preoperative magnetic resonance angiography. During Stent graft placement, the ICA wall could not be completely fit with a stent due to its stiff nature and the carotid curve. The gap between the stent and the ICA wall was filled using a coiling procedure on the first postoperative day.

Conclusions: Endovascular Stent graft placement for posttranssphenoidal carotid artery injury is a useful technical adjunct to the management strategy and has the potential to minimize the risk of having to sacrifice the ICA. In cases of incomplete reconstruction of the Stent graft placement due to its stiff nature and the carotid curve, an additional coiling procedure could be helpful to obliterate the gap between the stent and the ICA wall. To avoid carotid injury during transsphenoidal surgery, careful preoperative evaluation of vascular structures and meticulous surgical technique are necessary.

Publication types

  • Case Reports

MeSH terms

  • Angiography, Digital Subtraction
  • Angioplasty, Balloon / instrumentation*
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Carotid Artery Injuries / diagnosis
  • Carotid Artery Injuries / surgery*
  • Carotid Artery, Internal / surgery*
  • Carotid-Cavernous Sinus Fistula / diagnosis
  • Carotid-Cavernous Sinus Fistula / surgery*
  • Cerebral Angiography
  • Embolization, Therapeutic / instrumentation*
  • Emergencies*
  • Humans
  • Iatrogenic Disease
  • Imaging, Three-Dimensional
  • Intraoperative Complications / diagnosis
  • Intraoperative Complications / surgery*
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pituitary Neoplasms / surgery*
  • Postoperative Complications / diagnosis
  • Sphenoid Sinus / surgery
  • Stents*