Nineteen-Year Delayed Presentation of a Juxtaclinoid Internal Carotid Artery Pseudoaneurysm Following Craniofacial Trauma: A Case Report

Traumatic pseudoaneurysms of the internal carotid artery (ICA) typically present during the acute or subacute period following injury. Delayed presentation, defined as diagnosis months to decades after the inciting event, is extremely rare; fewer than 30 cases with a delay of more than 1 year have been reported in the literature. We report a case of posttraumatic ICA pseudoaneurysm with a 19-year delayed presentation, representing one of the longest reported intervals between initial trauma and pseudoaneurysm diagnosis to date. We report a 45-year-old male with a left juxtaclinoid/ophthalmic ICA pseudoaneurysm diagnosed 19 years after a motor vehicle accident. Recent magnetic resonance angiography demonstrated an oval-shaped lesion measuring 11.57 × 13.64 mm adjacent to the left juxtaclinoid ICA with intrasellar extension. Due to progressive headache, blurred vision, and nausea, endovascular treatment was performed, consisting of selective coil embolization followed by deployment of a 5 mm × 25 mm pipeline flow diverter. The patient was discharged neurologically intact the following day and remains on dual antiplatelet therapy with aspirin and clopidogrel. Delayed presentation of a traumatic ICA pseudoaneurysm is possible even decades after the initial injury. Long-term clinical and imaging surveillance should be considered in patients with a history of craniofacial trauma, even in the absence of acute symptoms. Endovascular reconstruction with flow diversion represents a viable vessel-preserving option in anatomically suitable cases.