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Letter: Pipeline Embolization Device for Treatment of Extracranial Internal Carotid Artery Pseudoaneurysms: A Multicenter Evaluation of Safety and Efficacy.

To the Editor: Reporting effective management strategies for uncommon conditions is always a challenge. We congratulate Akinduro et al1 and their team for their multicenter study in which the authors present the success by using Pipeline embolization device (PED) for extracranial internal carotid artery pseudoaneurysms. The PED (Medtronic Neurovascular, Dublin, Ireland) is a device that is useful as first-line treatment for selected intracranial aneurysms.2 Though initially approved by the United States Food and Drug Administration for aneurysms located between the petrous and the superior hypophyseal segments of internal carotid artery, they have been used beyond conventional indications by many endovascular experts.2-5 The extracranial external carotid artery pseudoaneurysm is an injury caused by the formation of an encapsulated paravascular hematoma that has no contact with blood circulation. Importantly, some authors suggest that the carotid pseudoaneurysm anatomically includes the common carotid.5 This series of cases, although small, opens the range of possibilities for patients with extracranial internal carotid artery pseudoaneurysms. The importance of the study lies in the fact that even though retrospective, multicenter data have been collected and evaluated for efficacy of PED in extracranial internal carotid artery aneurysms. Training of neurosurgeons shall include such endovascular interventions and supported by consensus guideline regarding patient selection and anticoagulation protocol standardization shall further improve the outcomes of these uncommon lesions. We believe that endovascular strategies for this type of lesions with flow diverters shall be considered in all patients presenting with extracranial internal carotid artery aneurysms. Funding