Case report:
A 22-year-old male patient presented with a history of neck pain for ten
days, for which he had muscle relaxants and SMT, which was followed
immediately by exacerbation of neck pain and swelling. Ten days later,
he had torticollis and recurrent bleeding attacks from nose and mouth,
after which he sought otorhinolaryngologist advice, who requested CT
angiography, which revealed hematoma in the nasopharynx and
pseudo-aneurysm from the distal cervical segment of the left ICA just
below the skull base (Fig.1). The patient was anemic but
hemodynamically stable. The right CFA was percutaneously accessed under
local anesthesia with (5ml xylocaine 2%), and while the
anesthesiologist continuously monitored the patient’s vital signs.
Flexor shuttle sheath (COOK® 6Fr. 90cm) was navigated over 0.035-in.
diameter soft glide wire (Terumo, Tokyo, Japan) together with bern
(Cook, Inc., Bloomington, IN, USA) catheter till the left
CCA—diagnostic angiography with manual hand injection of 10ml of
iopromide (Ultravist®) over 5sec. Confirmed the site of tear(Fig.2). BeGraft (Bentley InnoMed GmbH, Germany) (6mmX38mm)
covered stent graft was then advanced till the end of the straight part
of the cervical segment of ICA; guided by the help of roadmap, and
deployed via inflating of its balloon with 8atm pr. for 30sec.
Nitroglycerine was then injected, and completion angiography revealed
good sealing of the tear and restoration of the antegrade flow to the
brain (Fig.3). The patient was discharged on the following
postoperative day on broad-spectrum antibiotics, clopidogrel, and LMWH.
After three days, the last one was discontinued to be continued on
clopidogrel. Postoperative duplex days and 30; showed patent stent-graft
with normal ICA-waveform (Fig.4) and confirmed by CTA(Fig.5). The patient’s neck pain was resolved, and he regained
his normal tone of voice and stopped experiencing spitting blood
anymore.