Delayed development of brain abscesses following stent-graft placement in a head and neck cancer patient presenting with carotid blowout syndrome.
We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. Three months later, the patient suffered a recurrent hemorrhage. CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.
Oweis
Yaseen
Y
University of Michigan Medical School, Ann Arbor, MI 48109-0030, USA.
Gemmete
Joseph J
JJ
Chaudhary
Neeraj
N
Pandey
Aditya
A
Ansari
Sameer
S
D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D000792:Angiography; D021721:Balloon Occlusion; D019917:Blood Vessel Prosthesis Implantation; D001922:Brain Abscess / Q000175:diagnosis / Q000209:etiology*; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery*; D002341:Carotid Artery Thrombosis / Q000175:diagnosis / Q000209:etiology; D017536:Carotid Artery, Common; D020099:Coated Materials, Biocompatible; D004630:Emergencies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007822:Laryngeal Neoplasms / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D015607:Stents; D013577:Syndrome; D014057:Tomography, X-Ray Computed
D020099:Coated Materials, Biocompatible