Superficial Temporal Artery Cut Down to Facilitate Endovascular Treatment of External Carotid Artery Pseudoaneurysms

Carotid pseudoaneurysms are rare but may present a lifethreatening condition, particularly when associated with rupture, occlusion, or thromboembolism [1]. The etiology of carotid pseudoaneurysms includes blunt or penetrating trauma and vasculitis, as well as iatrogenic and unknown causes [1]. Historically, carotid pseudoaneurysms have been managed operatively by repair or ligation with percutaneous stenting and coil embolization emerging during the past two decades [2]. The surgery often is complicated due to the presence of associated scarring; therefore, the endovascular option has become attractive alternative with minimal morbidity and high success rate. However, introduction of a sheath or guiding catheter into the common carotid artery (CCA) can be difficult in patients with adverse aortic arch anatomy or concomitant atherosclerotic disease in the peripheral vessels or aorta. In addition, selectively catheterizing the external carotid artery (ECA) can be challenging due to the distorted anatomy by the pseudoaneurysm. We submit an exceptional case of superficial temporal artery cut down to facilitate ECA coil embolization after failed conventional approach from the common carotid artery route. To the best of our knowledge, this is the first case in the literature that describes this technique to treat ECA false aneurysm.