Target-specific multimodality endovascular management of carotid artery blow-out syndrome.
We describe a novel multimodality endovascular approach to safely control hemorrhage from a carotid artery pseudoaneurysm and tumor vasculature associated with a squamous cell carcinoma. This approach was used in the case of a 68-year-old man who had previously undergone a laryngectomy, chemotherapy, and brachytherapy and who subsequently experienced acute oropharyngeal bleeding. Angiography detected a carotid artery pseudoaneurysm and significant tumor vascularity. A target-specific multimodality approach was taken to embolize the potential etiologies for both the current and any future hemorrhages. Stent-assisted coiling of the pseudoaneurysm was successful. The tumor blush was treated with polyvinyl alcohol particles and both retrievable and nonretrievable coils. Endovascular surgeons have become increasingly involved in the management of patients with carotid injuries and with neoplasms in and around the skull base. Current endovascular technology provides a rapid target-specific approach to the treatment of carotid artery blow-out syndrome and has a greater potential to lower morbidity than does carotid sacrifice.
Levy
Elad I
EI
Department of Neurological Surgery, University of Pittsburgh Medical Center, Suite B400, 200 Lothrop St., Pittsburgh, PA 15213-2582, USA.
Horowitz
Michael B
MB
Koebbe
Christopher
C
Jungreis
Charles C
CC
D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000098:blood supply / Q000150:complications; D002340:Carotid Artery Diseases / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic; D006469:Hemoptysis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D015607:Stents; D013577:Syndrome; D014062:Tongue Neoplasms / Q000098:blood supply* / Q000150:complications