title: Carotid stent extrusion following carotid blowout.
abstract: OBJECTIVE
  We describe an unusual foreign body, a carotid stent extruded into the upper airway, and discuss the predisposing factors.
  
  
  METHODS
  This is a single patient case report with review of the literature.
  
  
  RESULTS
  Our patient is a 59 year old female treated for T3N2aM0 (stage IVa) left tonsil squamous cell carcinoma who experienced a carotid blowout treated by carotid stent placement with subsequent carotid coiling and vessel takedown. Approximately ten months later, she coughed and expelled approximately 3cm of tubular stent-appearing material into her airway causing acute stridor and dysphagia. CT angiography (CTA) showed the distal and proximal stent in proper position without evidence of extravasation. The stent was extracted transorally showing the distal end of the carotid to be patent and covered by fibrin within its lumen. Review of the literature shows that such stent extrusions, although rare, do occur.
  
  
  CONCLUSIONS
  Carotid stents are a valuable tool in cases of carotid blowout. However, long-term data on patient prognosis is lacking. The foreign body response triggered by stent placement can cause dislodgement. The potential for stent extrusion is greatest in patients who have preexisting ulceration or who have undergone radiation, both common in head and neck cancer patients.
authors.affiliation: Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA. Electronic address: nicole.aaronson@yale.edu.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Aaronson
authors.affiliation: Section of Interventional Neuroradiology, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Michele H
authors.initials: MH
authors.lastname: Johnson
authors.affiliation: Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Clarence T
authors.initials: CT
authors.lastname: Sasaki
mesh_terms: D000792:Angiography; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D009960:Oropharynx / Q000000981:diagnostic imaging*; D012422:Rupture, Spontaneous / Q000601:surgery; D000077195:Squamous Cell Carcinoma of Head and Neck; D015607:Stents; D014067:Tonsillar Neoplasms / Q000628:therapy*
keywords: Airway foreign body; Carotid blowout; Intraoperative brachytherapy; Stent extrusion; Tonsil cancer