title: Perforation of superior thyroid artery by guidewire during carotid artery stenting.
abstract: OBJECTIVE
  Although carotid artery stenting (CAS) has become a common treatment for carotid artery stenosis, some complications occur related to the procedures. Perforation of an external carotid artery (ECA) branch is a rare complication.
  
  
  METHODS
  An 83-year-old man presented with gait disturbance and dysarthria. MRI demonstrated a fresh cerebral infarction in the watershed territory of the left cerebrum and severe stenosis of the left internal carotid artery (ICA). He underwent CAS for the left ICA stenosis. After the procedure, the patient complained of discomfort of the throat. Swelling of the neck was observed and angiography showed extravasation of contrast medium from the superior thyroid artery. The patient was immediately sedated and intubated. Strict control of the blood pressure was continued. Two days after CAS, the tracheal tube was extracted. He was discharged without deficit on the 17th post-stenting day.
  
  
  CONCLUSIONS
  Injury of ECA branches is a potential complication when a guidewire is inserted during advancement of the materials. It may be life threatening due to associated respiratory problems. Once bleeding from the ECA is suspected, close observation of the patient's neck and respiration and immediate intervention are necessary.
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan nomura413jp@yahoo.co.jp.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nomura
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Seki
mesh_terms: D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects*; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D015607:Stents; D013961:Thyroid Gland / Q000098:blood supply*; D057772:Vascular System Injuries / Q000209:etiology*
keywords: CAS; external carotid artery; guidewire; perforation; superior thyroid artery