Facial and neck hematoma after carotid artery stenting: an uncommon misadventure in endovascular carotid revascularization.
The complication rates of carotid artery stenting (CAS) vary from 3.0% to 4.4%, and most commonly include ischemic stroke, intracranial hemorrhage, or groin complications. We present the rare complication of a patient who underwent CAS for a symptomatic 90% left internal carotid artery stenosis and developed an expanding cervical hematoma after the procedure with imminent respiratory compromise. After intubation, an arteriogram revealed perforation of the external carotid artery trunk, proximal to the origin of the internal maxillary artery. The artery was subsequently embolized and the hematoma resolved without further intervention. We present a potential catastrophic complication and suggest potential causes and treatment options available.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Ramesh
R
Grandhi
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Abhiram
A
Gande
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Nathan Thomas
NT
Zwagerman
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Brian Thomas
BT
Jankowitz
D016893:Carotid Stenosis / Q000601:surgery; D002548:Cerebral Revascularization / Q000009:adverse effects*; D004621:Embolization, Therapeutic; D005145:Face / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D019106:Postoperative Hemorrhage / Q000473:pathology / Q000628:therapy*; D015607:Stents / Q000009:adverse effects*
Atherosclerosis; Complication; Hemorrhage; Stent; guidewire