Hybrid Solution for Mycotic Pseudoaneurysm of Carotid Bifurcation.

Mycotic pseudoaneurysms of the extracranial carotid artery are rare and need surgical treatment to prevent rupture or embolization. We treated a case of a carotid bifurcation pseudoaneurysm secondary to infection caused by Staphylococcus epidermidis. We successfully treated it using a catheter balloon to obtain carotid bifurcation's control and replacing the carotid bifurcation with a vein graft. Management involves aneurysmectomy associated with antibiotic therapy and restoration of arterial continuity.

Can Carotid Endarterectomy be Performed Safely within 14 days after Intravenous Thrombolysis for Acute Stroke?

BACKGROUND: Carotid endarterectomy (CEA) represents a standard procedure in case of symptomatic carotid stenosis of 50-99% within 2 weeks from onset of stroke or transient ischemic attack (TIA) symptoms. The optimal time to perform CEA after intravenous thrombolysis (IVT) is still unclear. The aim of this study was to analyze the safety of CEA performed within 2 weeks from IVT. MATERIALS AND METHODS: A consecutive series of 70 patients affected by symptomatic carotid stenosis have been treated as per the international guidelines during 3 years. Eleven (15.7%) patients have been treated with IVT before CEA for ischemic stroke; remaining 59 (84.3%) patients received only CEA. CEA was performed in median 8 days (range: 2-13) after IVT. We examined the grade of disability before and after surgery as well as at 3 months follow-up, using the modified Ranking Scale (mRS). RESULTS: Among the patients who underwent CEA + IVT, CEA was performed in median 8 days (range: 2-13) after IVT. One patient received CEA within 48 hours from IVT, 3 patients within 72 hours, and 7 patients within 2 weeks. The complications within 90 days from surgery, in CEA + IVT group, were 3 cases of intracerebral hemorrhage (ICH) without symptoms. In patients who received only CEA, the complications were 1 case of stroke and 2 cases of ICH. The mortality registered was 0% in both groups. Among CEA + IVT group at 90 days after surgery, 9 patients had a mRS grade of 0-2, 2 patients had mRS of 3-5. CONCLUSIONS: In our series, IVT before CEA did not seem to increase the rate of complications. However, the study has several limitations, and further studies must be performed before solid evidence is available for recommendations regarding the timing of CEA after IVT.