2025 American Academy of Neurology Abstract Website

Objective:

To evaluate the safety and efficacy of flow-diverting stents in the treatment of extracranial ICA pseudoaneurysms, contributing to the growing body of literature on endovascular management of this rare condition.

Background:

Extracranial internal carotid artery (ICA) pseudoaneurysms are rare but potentially life-threatening lesions, often arising from trauma, iatrogenic injury, infection, or inflammatory conditions. Their management is complex, and while surgical treatment has been the traditional approach, endovascular techniques such as flow-diverting stents (FDS) have emerged as promising alternatives. FDS, including the Pipeline Embolization Device (PED) and the Surpass Streamline Flow Diverter (SSFD), have shown efficacy in treating intracranial aneurysms, but data on their use in extracranial ICA pseudoaneurysms remain limited.

Design/Methods:

This is a retrospective study of patients with extracranial ICA pseudoaneurysms treated with FDS at a tertiary academic institution between January 1, 2010, and July 1, 2024. Patient demographics, pseudoaneurysm characteristics, procedural details, efficacy in aneurysm occlusion, complication rates, and follow-up data were collected. All patients underwent treatment with either the PED or SSFD.

Results:

Seven patients with eight pseudoaneurysms were treated using FDS (seven with PED and one with SSFD). The patient cohort had a mean age of 54.9 years, consisting of four females and three males. The most common etiology was trauma (50%), followed by iatrogenic injury (25%) and spontaneous rupture (25%). In all cases, FDS were used as standalone treatments. There were no procedural or immediate post-procedural complications, and follow-up imaging at a mean of 15.3 months demonstrated complete obliteration in five patients (62.5%) and near-complete occlusion in two patients (25%). No instances of in-stent thrombosis or device migration were reported.

Conclusions:

Flow-diverting stents are a safe and effective treatment for extracranial ICA pseudoaneurysms, offering a minimally invasive alternative to traditional surgical approaches. In this study, FDS were associated with high rates of pseudoaneurysm occlusion and no complications.