Annals of vascular surgery
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Case Reports
Endovascular treatment of traumatic carotid pseudoaneurysm with stenting and coil embolization.
Posttraumatic internal carotid pseudoaneurysm is an infrequent but potentially life-threatening condition that complicates approximately one-third of blunt carotid injuries. Other types of injuries include dissection, thrombosis, and complete disruption. Historically, carotid pseudoaneurysms have been managed operatively with repair, ligation, and anticoagulation, with percutaneous angioplasty and stenting emerging over the past decade. We present the case of a 19-year-old patient with a posttraumatic internal carotid pseudoaneurysm that increased in size with conservative management and was treated with coil embolization and stenting.
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We examined subclinical alterations of cerebral function during carotid endarterectomy (CEA) and predictability of minor cerebral damage by perioperative levels of biochemical markers of brain damage (S100B and neuron-specific enolase [NSE]). Twenty consecutive patients with > or =70% asymptomatic carotid stenosis undergoing elective CEA were enrolled. Pre- and postoperative testing included magnetic resonance imaging (MRI) of the head, a standardized neurological exam, a battery of neuropsychological tests, and measurement of serum levels of S100B and NSE. ⋯ In one patient, a significant decline of cognitive function was observed. This was the only individual to obtain a consistently high S100B and NSE increase. Neuropsychological testing combined with measurements of S100B and NSE may improve sensitivity when assessing subtle cerebral damage following CEA.