CASE-REPORT: RECURRENT EMBOLIC STROKE FROM NON-TRAUMATIC PSEUDOANEURYSM OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY IN A 60-YEAR OLD WOMAN

Download or read book CASE-REPORT: RECURRENT EMBOLIC STROKE FROM NON-TRAUMATIC PSEUDOANEURYSM OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY IN A 60-YEAR OLD WOMAN written by Nils Peters and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Extracranial carotid artery aneurysms and pseudoaneurysms may be caused by atherosclerosis, trauma, past endarterectomy and connective tissue disorders. Aneurysms may become symptomatic by mass effect, rupture, thrombosis and embolism. Pseudoaneurysm especially of non-traumatic or postoperative etiology is rare, optimal management is unclear. Observational data suggests that with conservative treatment with antiplatelet agents or anticoagulation, ischemic complications are rare in a large number of patients. Surgical or endovascular treatment tends to be performed in high-risk settings.Case: We present the case of a 65-year old woman who suffered three embolic ischemic strokes of the left carotid vascular territory (M1-occlusion; A2- und M1-subocclusion; M1-occlusion) within 2 months. Each time, there was a comparatively mild clinical deficit (NIHSS 3-4), and rapid recanalization by endovascular treatment (twice) or iv-thrombolysis (once), respectively, led to very good clinical recovery. A pseudoaneurysm of the left extracranial internal carotid artery was identified as the source of the emboli. We hypothesize that it resulted from past dissection caused by fibromuscular dysplasia, or possibly mechanical irritation from a prominent styloid process (Eagle's syndrome). There was no history of trauma or surgery of the neck. Antiplatelets and additional oral anticoagulation with a vitamin-K-antagonist started after the first two events proved ineffective for prevention of recurrence. Thus, endovascular repair by placement of a flow-diverter was performed.Conclusion: Our case illustrates that embolism originating from a non-traumatic carotid pseudoaneurysm may recur despite aggressive medical therapy in a short time. Endovascular or surgical treatment represents an alternative for the prevention of ischemic stroke.