Endovascular reconstruction of extracranial carotid artery dissecting pseudoaneurysms: multicenter cohort study

Background Dissecting pseudoaneurysms (dPSAs) of the extracranial carotid artery are often managed conservatively, but persistent or enlarging dPSAs, recurrent ischemic events despite medical therapy, or symptomatic mass effect may warrant endovascular reconstruction. This study evaluated the safety, angiographic efficacy, and cost implications of endovascular treatment using self-expanding carotid stents (CS) or flow-diverter stents (FDS). Methods In this retrospective multicenter cohort study, patients with extracranial carotid dPSAs treated with CS or FDS at four neurovascular centers were evaluated. Demographics, procedural data, clinical and angiographic outcomes were analyzed. Aneurysm occlusion was graded using the O9Kelly–Marotta (OKM) classification. Device utilization and estimated device-related costs were compared. Results Among 205 treated patients, 182 met the inclusion criteria. The median age was 49 years and 46.7% were female. CS were used in 107 patients (58.8%) and FDS in 75 (41.2%). Periprocedural ischemic stroke occurred in two patients (1.1%); both achieved a favorable 90-day functional outcome. At final follow-up, near-complete or complete occlusion (OKM grades C–D) was achieved in 177 patients (97.3%). CS treatment was associated with faster occlusion than FDS (mean time to OKM grades C–D, 3.8 vs 8.8 months; P=0.011) and independently predicted complete occlusion at early and final follow-up. Device utilization was similar, whereas estimated mean device cost was lower with CS. Conclusion Endovascular reconstruction of extracranial carotid dPSAs was associated with high occlusion rates and low periprocedural morbidity. Compared with FDS, self-expanding CS achieved faster and more complete occlusion with similar device utilization and substantially lower estimated device-related costs.