Revascularización cerebral inusual tras la corrección de un pseudoaneurisma carotídeo recurrente

Introduction. The appearance of pseudoaneurysms following a carotid endarterectomy is an infrequent complication. Their correction is associated with a notable rate of morbidity and mortality, and if it becomes impossible to re-establish a continuous flow, arterial ligation may even become necessary. Case report. A 73-year-old male with a pseudoaneurysm that developed 11 years after the initial correction of a first pseudoaneurysm that required ligation of the primitive carotid artery. The full haemodynamic study (by duplex and transcranial Doppler) confirmed the presence of a pseudoaneurysm, the occlusion of the primitive carotid and the patency of the internal and external carotid arteries (ICA and ECA, respectively). Moreover, correct perfusion of the middle cerebral artery was also observed directly by the reversed flow originated in the ECA. Given these findings and the suspicion of an infectious substrate, resection of the pseudoaneurysm and an end-to-end ICA/ECA anastomosis were performed; both conventional (anatomical/extraanatomical) revascularisation and distal arterial ligation were rejected. Perioperative cultures were positive for Staphylococcus aureus. In the immediate post-operative period, no neurological events or injuries to cranial nerves were observed. The patient was kept on home treatment with antibiotics (cloxacillin) for six weeks. An ultrasonography examination at one month and at six months of follow-up confirmed the patency of the technique and the absence of signs of over-infection. Conclusions. This case reflects the benefits of performing a full intra/extracranial haemodynamic study prior to establishing an optimal revascularisation strategy in unusual clinical situations. Furthermore, it confirms the potential viability of utilising the ECA as a suitable direct entrance for cerebral revascularisation in the presence of occlusion of the primitive carotid. [ANGIOLOGIA 2009; 61: 35-40]