On the Cover Yale vascular neurosurgeons continue to innovate making the treatment of complex neurovascular pathologies safer and more effective

A young woman presented to Yale-New Haven Hospital (YNHH) with worsening headaches, difficulty swallowing, and weakness of the right side of her tongue. She found swallowing so uncomfortable that she was loosing weight.

ICA pseudoaneurysm

The problem was a large pseudoaneurysm in her neck arising from the blood vessel going to her brain — the internal carotid artery (ICA).

The pseudoaneurysm was so large that it compressed the nerve controlling the right-side of her tongue.

A multi-disciplinary team of vascular specialists discussed her case and decided on an innovative treatment strategy — the use of overlapping Pipeline Flex Embolization Devices (PED Flex, Medtronic Neurovascular) to reconstruct her ICA and exclude the aneurysm from the circulation. PED Flex is only approved for the treatment of a small subset of intracranial aneurysms. This was thinking outside the box!

In a team led by Dr. Charles Matouk, Section Chief of Neurovascular Surgery, her right ICA was reconstructed using 5 overlapping PED Flex devices. One week later her symptoms were improved. One month later they were completely resolved.

A repeat diagnostic angiogram performed 2 months after the procedure demonstrated near-complete exclusion of the aneurysm from the circulation.

This technique was so innovative that it is featured on the Cover of the May 2018 issue of the Journal of Vascular Surgery.

Complex neurovascular disease often requires a team approach to achieve the safest and best results. Treatment decisions often require collaboration between neurologists, interventional radiologists, vascular surgeons, and vascular neurosurgeons, as it did in this case.

Yale Neurovascular Surgery is the largest neurovascular practice in Connecticut and one of the largest in New England. Our high volumes give us the experience to innovate and provide the safest, most effective treatments for the most complex disease.

Created By
Charles Matouk

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