Case Report: Therapy of an Enormous Extracranial Carotid Artery Aneurysm With a Covered Coronary Stent in an Infant and Review of Literature

Infectious pseudoaneurysms, though rare, pose a serious complication with mortality rates up to 77%. To date, and due to the rare incidence, no evidence-based treatment guidelines for pediatric patients are published. Different approaches have been outlined in the literature including conservative, surgical, or endovascular treatment. We report a case of a 2-year-old boy with chronic cervical lymphadenopathy for about 2 months. In an elective lymphadenectomy, a large aneurysmal bulge was noticed. MR and CT angiography revealed a particularly pronounced pseudoaneurysm of the left internal carotid artery (ICA), causing significant compression of the naso- and oropharynx. After interdisciplinary consultation with vascular surgeons, pediatric surgeons and neurosurgeons, surgical intervention was judged not possible due to its proximity to the skull base; hence, ligation of the ICA was proposed. Based on our interventional experience and to maintain perfusion of the left ICA, we opted for endovascular stenting. Implantation of a covered coronary stent was successfully performed with no perioperative neurologic or cardiopulmonary complications. Follow-up imaging 6 years after stent implantation showed moderate in-stent stenosis that was treated successfully with a percutaneous transluminal angioplasty. As of today, the patient remains well beside the residual mild and incomplete Horner's syndrome, which was pre-existing before intervention. Endovascular treatment of extracranial carotid artery pseudoaneurysms with covered coronary stent systems can be used as a safe and efficacious approach also in pediatric patients with excellent outcome 6 years after the intervention.