Flow Diversion for an Extracranial Infectious Internal Carotid Pseudoaneurysm Secondary to Exudative Otitis Media: Illustrative Case

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Objective: Treatment of infectious aneurysms is challenging because of the fragility of the vessel walls. Surgical trapping and endovascular parent artery occlusion are the treatments of choice for medically intractable infectious aneurysms. Here, we describe a patient with an infectious aneurysm at the extracranial petrous segment of the internal carotid artery that was secondary to exudative otitis media; it was successfully treated with reconstructive endovascular interventions using a flow redirection endoluminal device (FRED).

Case Presentation: A 57-year-old man was administered antibiotics for exudative otitis media. After 6 months, the patient underwent CT screening, which revealed destruction of the petrous bone and a pseudoaneurysm at the petrous segment of the left internal carotid artery. Catheter angiography, including a balloon occlusion test, revealed a 47-mm wide-necked pseudoaneurysm at the distal cervical segment of the left internal carotid artery with poor collateral blood supply to the left internal carotid artery. We performed reconstructive endovascular treatment using a FRED. A follow-up catheter angiogram after 6 months confirmed a minor neck remnant of the aneurysm.

Conclusion: Flow diversion may be a useful treatment approach for extracranial infectious aneurysms, despite concerns about incomplete obliteration of the aneurysm and the persistent risk of re-rupture before complete obliteration.