E-012 Treatment of iatrogenic carotid artery pseudoaneurysm with multiple pipeline embolization devices

Introduction/purpose Iatrogenic internal carotid artery pseudoaneurysm formation is a rare surgical complication that can be treated with either reconstructive or deconstructive techniques. More recently, endovascular flow diversion has been used successfully for treatment of intracranial blister aneurysms. We report a case of persistent and enlarging traumatic pseudoaneurysm opacification after initial flow diversion without a deconstructive option. This presents a unique challenge to the neurointerventionalist. Materials and methods The electronic medical record and radiologic electronic database were utilized to review patient imaging and obtain relevant de-identified images. Pubmed was utilized to perform a literature review. Results 62-year-old patient with iatrogenic internal carotid artery pseudoaneurysm after transphenoidal macroadenoma resection was successfully treated with eleven pipeline embolization devices. Persistent enlargement of the pseudoaneurysm was noted during initial pipeline placement. Thus, we placed several overlapping PEDs. However, the pseudoaneurysm continued to enlarge with brisk inflow. The hypoplastic ACOM precluded any deconstructive option. Additionally, because of tortuous anatomy and pseudoaneurysm location in the carotid siphon, a covered stent was not an option. Therefore, we continued to place overlapping PEDs until arterial inflow and pseudoaneurysm size decreased. Follow-up exams at three months and one year demonstrated complete aneurysm occlusion. Intimal irregularly and intra-device contrast layering at the three-month post-procedure angiogram was treated with continued dual-antiplatelet therapy and had completely resolved at the one-year angiogram. Conclusion Iatrogenic internal carotid artery pseudoaneurysms can be successfully treated with multiple overlapping Pipeline Embolization Devices with good radiologic and clinical outcomes. Disclosures C. Green: None. A. Ferrell: None. P. Brown: None. P. Kvamme: None.