Hayami Hiromichi, Fukutome Kenji, Aketa Shuta, Fukumori Junji, Mitsui Takaaki, Shiraishi Yuki, Matsuoka Ryuta, Mori Naoki, Tei Rinsei, Shin Yasushi, Motoyama Yasushi
Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan.
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
J Neurosurg Case Lessons. 2024 Sep 16;8(12). doi: 10.3171/CASE24383.
Extracranial carotid artery aneurysms (ECAAs) are rare, and treatment guidelines are lacking. Few reports on endovascular treatments performed for ECAAs exist.
A 73-year-old woman with a left giant cervical internal carotid artery aneurysm was treated with overlapping closed-cell stents. The aneurysm regrew 1 year after the treatment, and then a covered stent was deployed. Angioscopy was performed to confirm neointimal development to determine the appropriate stent position before the retreatment, and it revealed that the stent struts were embedded in thick neointima for the most part but that the neointima was thin around the aneurysm neck. Multiple holes connecting to the aneurysm were observed between the stent struts. A covered stent overlapped inside the closed-cell stents, and blood flow into the aneurysm completely disappeared.
When deploying the covered stent for recurrent aneurysms, angioscopy is useful for confirming neointimal development and determining the appropriate stent length and position. Angioscopic observations suggest that using stents with a higher mesh density and smaller pore size can reduce the neck hole size of the aneurysm and may achieve complete occlusion of the aneurysm. https://thejns.org/doi/10.3171/CASE24383.
颅外颈动脉动脉瘤（ECAA）较为罕见，且缺乏治疗指南。关于ECAA血管内治疗的报道很少。
一名73岁女性患有左侧巨大颈内动脉动脉瘤，接受了重叠闭孔支架治疗。治疗1年后动脉瘤复发，随后植入了覆膜支架。在再次治疗前，进行血管内镜检查以确认新生内膜的生长情况，从而确定合适的支架位置，结果显示支架支柱大部分嵌入厚新生内膜中，但动脉瘤颈部周围的新生内膜较薄。在支架支柱之间观察到多个与动脉瘤相连的孔洞。在闭孔支架内重叠植入了覆膜支架，动脉瘤内的血流完全消失。
对于复发性动脉瘤植入覆膜支架时，血管内镜检查有助于确认新生内膜的生长情况，并确定合适的支架长度和位置。血管内镜观察表明，使用网眼密度更高、孔径更小的支架可减小动脉瘤颈部孔洞大小，并可能实现动脉瘤的完全闭塞。https://thejns.org/doi/10.3171/CASE24383 。
