Purpose To demonstrate the safety and efficacy of stent assisted, coil embolization for a large fusiform aneurysm that developed in a previously placed saphenous venous graft in the distal CCA and proximal ICA.
Clinical Presentation A 44-year-old male presented with sudden onset of left hemiplegia, dysarthria and left hemianopia. An MRI brain revealed a large acute ischemic stroke the right temporo-parietal cortex and basal ganglia. A subsequent diagnostic angiogram revealed a large fusiform vein graft aneurysm measuring 3 cm by 2.5 cm engulfing the distal CCA and the origin of the ICA. A decision was made to perform covered stent assisted coiling of the aneurysm after vascular surgery deemed the procedure to carry too high a risk for intraoperative stroke. Treatment was delayed by 4 weeks due to the increased risk of hemorrhagic conversion of the large ischemic stroke.
Technique Procedure was performed under conscious sedation. Two Precise stents were deployed across the aneurysm neck after jailing a Prowler 14 microcatheter inside the aneurysm sac to prevent coil herniation into the parent vessel. After filling the sac with coils, a covered Viabahn stent was successfully deployed across the aneurysm neck thereby achieving complete occlusion of the aneurysm while maintaining patency of the vessel lumen.
Conclusion Covered stent assisted coiling for treatment of carotid artery vein graft aneurysms is a safe and effective treatment for a difficult vascular lesion. The patient was discharged home with complete resolution of the presenting symptoms and a NIH stroke scale of 0. This is the first reported case of successful endovascular treatment of an aneurysm developing in a vein graft in the carotid artery.
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