Radiotherapy-induced common carotid pseudoaneurysm presenting with initially occult upper airway hemorrhage and successfully treated by endovascular stent graft

Ellens, Damien J.; Hurley, Michael C.; Surdel, Daniel; Shaibani, Ali; Pelzer, Harold J.; Bendok, Bernard R.

doi:10.1016/j.amjoto.2008.12.005

Cited by 25 publications

(32 citation statements)

References 21 publications

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“…5–7,13,14) Additionally, some authors have reported good long-term results of endovascular management for patients with soft-tissue lesions and tumor regression (average survival time: 34 months), 15) as we also observed in our case. Furthermore, it is possible that a covered or flow-diverter stent may be effective against carotid blowout syndrome in an emergent hemostatic situation.…”

Section: Discussionsupporting

confidence: 82%

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Endovascular Therapy for a Post-irradiated Cervical Pseudoaneurysm at the Carotid Stump: A Case Report

Arihara

Miyata

Iihoshi

et al. 2017

NMC Case Report Journal

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A nearly 80-year-old man with a history of radiotherapy (RT) and total laryngectomy for laryngeal cancer 25 years previously presented with a rapidly growing mass on the right side of his neck. A huge pseudoaneurysm (pseudoAN) was detected at the right carotid bifurcation, though angiography performed four years previously had shown total occlusion of the internal carotid artery. Stent-assisted coil embolization enabled aneurysm sac shrinkage. Clinicians must be aware that the stump of an arterial occlusion associated with RT can change into a pseudoAN over the long term and must provide follow-up in such cases.

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Section: Discussionsupporting

confidence: 82%

“…Furthermore, it is possible that a covered or flow-diverter stent may be effective against carotid blowout syndrome in an emergent hemostatic situation. 14,16) …”

Section: Discussionmentioning

confidence: 99%

Endovascular Therapy for a Post-irradiated Cervical Pseudoaneurysm at the Carotid Stump: A Case Report

Arihara

Miyata

Iihoshi

et al. 2017

NMC Case Report Journal

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“…Endovascular treatment provided a possible alternative with fewer procedure-related complications and better outcomes. Tables 3 [4][5][6][7][8][16][17][18][19] and 4 4,5,7,18,[20][21][22][23][24] summarise the experience of both destructive and reconstructive treatment of acutely ruptured ICA pseudoaneurysms reported in the literature. Immediate haemostasis was achieved in all cases.…”

Section: Discussionmentioning

confidence: 99%

“…Our initial experience with coronary stents was satisfactory, thus we continued the reconstruction of ICAs with covered stents when they became available. Case reports have suggested that covered stents, [21][22][23]29,30 and even multiple overlapping stents are feasible. 31 Flow-diverting stents have recently gained popularity for treating ICA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of ruptured internal carotid artery pseudoaneurysms after irradiation for nasopharyngeal carcinoma patients

Mak¹,

Cheng²,

Cheung³

et al. 2013

Hong Kong Med J

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229Objectives To evaluate the efficacy and complications of endovascular treatment for ruptured internal carotid artery pseudoaneurysms following irradiation of nasopharyngeal carcinoma.Design Retrospective case series.Setting Tertiary neurosurgical referral unit of a Hong Kong public hospital.Patients Patients with ruptured radiation-induced internal carotid artery pseudoaneurysms that were treated endovascularly from October 1999 to October 2011 at Queen Elizabeth Hospital were reviewed. Hospital records, imaging, and angiographic data were studied.Results During the study period, 15 such nasopharyngeal carcinoma patients were treated by endovascular means at Queen Elizabeth Hospital. Ten presented with epistaxis, three with otorrhagia (bleeding from the ear), and two with both. Therapeutic occlusion of the affected internal carotid artery was performed in four patients, and stenting of the artery (with or without coil obliteration of the pseudoaneurysm) was performed in 11. Immediate haemostasis was achieved in all cases. One (7%) of the 15 patients endured symptomatic recurrence of the pseudoaneurysm, and in another an asymptomatic residual pseudoaneurysm was noted in the follow-up angiogram. Three patients suffered clinically significant procedure-related complications, including cerebral infarction (n=2) and brain abscess (n=1). In the angiograms obtained after a mean posttreatment interval of 13 (range, 0.7-60) months, the stent patency rate was 67%. All three patients with occluded stents were asymptomatic.Conclusions Ruptured internal carotid artery pseudoaneurysms following radiotherapy is a rare but life-threatening condition. Endovascular treatment by occlusion or reconstruction of the internal carotid artery with stents provides immediate haemostasis and obliteration of the pseudoaneurysms, with a low recurrence rate. Long-term follow-up is necessary to look out for delayed posttreatment complications.

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“…Post-irradiated carotid pseudoaneurysms after radiotherapy for nasopharyngeal cancer typically occur at the petrous and laceral carotid artery, and may present with life-threatening epistaxis due to carotid blowout syndrome (CBS) 2. Recognized treatments for these lesions include parent artery occlusion (PVO) with or without revascularization, endovascular coil embolization, and covered stenting 3 4. The introduction of endovascular flow diverters provides another potential treatment option.…”

Section: Introductionmentioning

confidence: 99%

Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device

Tsang

Leung

Lee

et al. 2014

J NeuroIntervent Surg

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Radiotherapy-induced common carotid pseudoaneurysm presenting with initially occult upper airway hemorrhage and successfully treated by endovascular stent graft

Cited by 25 publications

References 21 publications

Endovascular Therapy for a Post-irradiated Cervical Pseudoaneurysm at the Carotid Stump: A Case Report

Endovascular Therapy for a Post-irradiated Cervical Pseudoaneurysm at the Carotid Stump: A Case Report

Endovascular treatment of ruptured internal carotid artery pseudoaneurysms after irradiation for nasopharyngeal carcinoma patients

Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device

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