A novel treatment approach for common carotid artery bifurcation aneurysms

Introduction

An aneurysm involved in common carotid artery (CCA) bifurcation is a rare clinical condition. There are not enough natural follow-up data, and there is no evidence-based treatment algorithm [1]. An endovascular approach is used to treat CCA bifurcation aneurysms, as it offers some advantages in selected patient populations; nonetheless, closure of the aneurysmal segment in CCA bifurcation using a graft stent has some challenges, mainly occluding the ostial part of the external carotid artery (ECA). Coil embolization of a CCA bifurcation aneurysm is preferred over graft stent implantation in this condition; however, coil embolization cannot provide appropriate treatment in patients suffering from a CCA bifurcation aneurysm with significant stenosis in the proximal part of the internal carotid artery (ICA).
Herein, we present a male patient whose CCA bifurcation aneurysm with significant stenosis in the proximal part of the ipsilateral ICA was successfully treated with the implantation of two nested self-expandable closed-cell stents.

Case report

A 54-year-old hypertensive male patient was admitted to our clinic due to recurrent episodes of transient ischemic attack in the last 3 months. His carotid angiography revealed a right-sided CCA bifurcation aneurysm with 50–60% stenosis in the proximal part of the ICA (Figure 1 A). Due to the possibility of occluding the ostial part of the right ECA if we close the aneurysmal segment with a graft stent, we preferred to close the aneurysmal segment by implanting two nested self-expandable closed-cell stents. The patient had already been on 100 mg/day aspirin for 2 months and received a 300 mg loading dose of clopidogrel the day before the procedure. A written informed consent form was provided before the procedure. A 40 × 8–6 mm Xact stent (Abbott Vascular, USA) was implanted successfully after the Emboshield NAV6 Embolic Protection System (Abbott Vascular, USA) had been placed distally to the target lesion (Figure 1 B). However, we observed that the CCA bifurcation aneurysm persisted after stent implantation (Figure 1 C). Therefore, a 30 × 7 mm Xact stent (Abbott Vascular, USA) was implanted inside the first stent. The final carotid injection showed that the aneurysm was substantially closed (Figure 1 D). After the procedure, a combination of clopidogrel 75 mg/day and aspirin 100 mg/day was planned for 2 months and aspirin 100 mg/day indefinitely. The patient was scheduled...


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