PMC8186303_01
Multidetector computed tomography angiography of the left carotid artery. Maximum intensity projection images in sagittal section (A) and coronal section (B) showing 2 separate pseudoaneurysms, a largesized, fusiform-shaped (solid white arrow) along the posterolateral wall and another small-sized, oval-shaped along the anteromedial wall (dashed white arrow) arising at the same level from the distal segment of the left common carotid artery below the bifurcation
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F1
The multi-detector computed tomography (MDCT) scan revealed the presence of 2 different PSAs, one larger in size and fusiform in shape, and the other smaller sized, oval-shaped from the posterolateral and anteromedial walls of the common carotid artery, respectively (Figure 1).
Selective angiography of the left common carotid artery. Pseudoaneurysms showing in 2 different phases of filling, (A) partially and (B) near-complete filling phases due to slow, phasic filling secondary to their narrow necks (black asterisks; a). It demonstrated 2 separate pseudoaneurysms: a largesized, fusiform (solid white arrow) and another small-sized, oval-shaped (dashed white arrow) arising at the same level from the left common carotid artery below the bifurcation
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F2
A selective carotid angiogram showed 2 PSAs as described earlier from the distal segment of left CCA below the bifurcation with an appropriate landing zone (Figure 2).
Cine fluoroscopy of the left neck region. A partially expanded self-expanding covered stent seen across the distal segment of the left common carotid artery
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F3
We decided to treat the patient with a stent graft [covered stent]; hence, a 25 x 7 mm Viabahn (Gore and associates, USA) self-expanding covered stent was then expanded in the CCA across both of the PSAs leading to their complete closure (Figures 3 and 4).
Conventional angiography of the left carotid artery. Deployment of the covered stent (curved white dashed line) leading to the complete closure of both of the pseudoaneurysms with the normal flow in the left carotid system
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F4
We decided to treat the patient with a stent graft [covered stent]; hence, a 25 x 7 mm Viabahn (Gore and associates, USA) self-expanding covered stent was then expanded in the CCA across both of the PSAs leading to their complete closure (Figures 3 and 4).