title: Distal marginal stenosis: a contributing factor in delayed carotid occlusion of a patient with carotid blowout syndrome treated with stent grafts.
abstract: Distal marginal stenosis is rarely reported to be a factor associated with poor long-term patency of patients of head and neck cancers with carotid blowout syndrome treated with stent grafts. We report a case of laryngeal cancer with rupture of the right common carotid artery. A self-expandable stent graft was deployed, but bleeding recurred. Another stent graft was deployed for the pseudoaneurysm located distal to the first stent graft. Rebleeding occurred because of pseudoaneurysm formation from reconstituted branches of the right superior thyroid artery. We performed direct percutaneous puncture of the proximal superior thyroid artery for successful embolization. Distal marginal stenosis and asymptomatic thrombosis of the carotid artery were noted at 3.5- and 5-month follow-ups, respectively. We suggest aggressive early follow-up and reintervention for distal marginal stenosis by combined antibiotic therapy and angioplasty and stenting to improve the long-term patency of stent-graft deployment for management of carotid blowout syndrome.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C. fcchang374@gmail.com
authors.forename: Feng-Chi
authors.initials: FC
authors.lastname: Chang
authors.forename: Chao-Bao
authors.initials: CB
authors.lastname: Luo
authors.forename: Jiing-Feng
authors.initials: JF
authors.lastname: Lirng
authors.forename: Wan-Yuo
authors.initials: WY
authors.lastname: Guo
authors.forename: Michael Mu-Huo
authors.initials: MM
authors.lastname: Teng
authors.forename: Hsiu-Mei
authors.initials: HM
authors.lastname: Wu
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Chang
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000628:therapy; D002340:Carotid Artery Diseases / Q000628:therapy*; D016893:Carotid Stenosis / Q000209:etiology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000601:surgery; D008297:Male; D012422:Rupture, Spontaneous; D015607:Stents; D014654:Vascular Patency