title: Radiotherapy-induced common carotid pseudoaneurysm presenting with initially occult upper airway hemorrhage and successfully treated by endovascular stent graft.
abstract: Radiation induced carotid vasculopathy may present as steno-occlusive disease or less commonly as a pseudoaneurysm. The latter most often presents with a pulsatile mass but is a potential cause of life threatening hemorrhage. We present a case of a small common carotid artery (CCA) pseudoaneurysm that was initially dismissed as the cause of the patients presenting epistaxis given its small size and location. After standard bilateral internal maxillary artery embolizations failed to prevent significant subsequent pharyngeal and tracheal blood loss and serial imaging demonstrated a progressive enlargement of the pseudoaneurysm, a stent graft was successfully placed across the lesion. At five months post stenting, follow-up imaging of the neck showed a stable obliteration of the pseudoaneurysm, good arterial patency, and the patient remained free of recurrent hemorrhage. This case demonstrates that even a small carotid pseudoaneurysm, can present with pharyngeal hemorrhage and should be treated aggressively--with endovascular stent grafting being a preferred treatment modality for arterial lesions in the irradiated neck.
authors.affiliation: Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: Ellens
authors.forename: Michael C
authors.initials: MC
authors.lastname: Hurley
authors.forename: Daniel
authors.initials: D
authors.lastname: Surdel
authors.forename: Ali
authors.initials: A
authors.lastname: Shaibani
authors.forename: Harold
authors.initials: H
authors.lastname: Pelzer
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D020212:Carotid Artery Injuries / Q000209:etiology* / Q000628:therapy; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D011832:Radiation Injuries / Q000150:complications*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome