Combined Pipeline Embolization Device with Endoscopic Endonasal Fascia Lata/Muscle Graft Repair as a Salvage Technique for Treatment of Iatrogenic Carotid Artery Pseudoaneurysm

Abstract

The incidence of internal carotid artery (ICA) injury associated with endoscopic endonasal approaches to the pituitary is less than 1%. While parent vessel sacrifice has historically been the choice of treatment, vessel-preserving endovascular techniques have been reported. Although flow diversion offers endoluminal reconstruction, its major limitation is the delay in obtaining complete occlusion. We describe the use of a combined Pipeline embolization device (PED) with endoscopic endonasal repair using a fascia lata/muscle graft to treat an iatrogenic ICA pseudoaneurysm and report long-term radiographic follow-up. Further investigation into the utility of directed endoscopic endonasal repair of iatrogenic pseudoaneurysms initially treated with PED is necessary, especially given the need of post-PED anticoagulation and the rate of permanent neurological deficit after ICA sacrifice.

Keywords

endoscopic endonasal - fascia lata - iatrogenic carotid injury - muscle graft - pituitary adenoma - Pipeline embolization - pseudoaneurysm

Disclosures

Dr. Alexander L. Coon is a proctor for the Woven Endobridge (WEB) device (Sequent Medical); a proctor for the Surpass device (Stryker Neurovascular), and a consultant for Stryker Neurovascular; a proctor for the PED (Medtronic Neurovascular) and a consultant for Medtronic; a proctor for the FRED device (MicroVention) and consultant for MicroVention; and a consultant for InNeuroCo. Dr. Nyall R. London holds stock in Navigen Pharmaceuticals and was a consultant for Cooltech Inc., both of which are unrelated to the present manuscript. Dr. Cameron G. McDougall is a consultant for Microvention and Medtronic.

Source of Financial Support and Industry Affiliations

None.

Publikationsverlauf

Eingereicht: 15. September 2020

Angenommen: 14. Januar 2021

Artikel online veröffentlicht:
01. Dezember 2021

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