Article Figures & Data
Figures
- Fig 1.
Endovascular treatment of traumatic ICA pseudoaneurysm.
A, Initial angiogram reveals a large pseudoaneurysm at the carotid canal.
B, After endovascular repair with GDCs, a small aneurysmal neck remnant remains (arrow).
C, GDC packing and aneurysmal growth are noted on the 10-month follow-up angiogram; note coil herniation into middle cranial fossa (arrow). The aneurysmal remnant could not be fully packed with GDCs without the use of endovascular stent reconstruction.
D, As a result, a stent was placed at the aneurysmal orifice (arrow) and was deployed.
E, Additional GDCs could then be detached to complete the repair.
- Fig 2.
Endovascular treatment of HNC-related CBS by use of the self-expanding, covered Wallgraft stent.
A, Initial angiogram reveals a stump (arrow) at the proximal external carotid artery.
B, Microcatheter injection of the stump during endovascular exploration confirms a pseudoaneurysm as the source of hemorrhage.
C, An 8 × 30 mm Wallgraft stent is positioned within the common carotid artery and ICA junction, bridging the external carotid artery origin.
D, After deploying the stent, angiography shows exclusion of the pseudoaneurysm and normal caliber of the parent, stented artery.
E, Digital subtraction angiogram mask is shown for detail.
F, Photograph of the Wallgraft stent is shown for detail.
Tables
Endovascular repair of carotid blowout syndrome: summary of clinical data
Age (yr)/Sex Clinical History Event (No.) Pathologic Lesions CBS Group Treatment Outcome/Follow-up Complication 34/M Trauma (Fig 1) 1 Petrous ICA Psa I GDCs placed in Psa rCBS/10 mo 2 Petrous ICA Psa I 4 × 8 mm AVE stent; GDCs placed through stent in Psa DH/2 yr 36/F Trauma 1 ICA Psa I 4 × 9 NIR and 6 × 20 mm SMART stents DH/1.4 yr 70/M SCCa, ND, XRT 1 Direct tumor involvement of ICA/CCA I 8 × 40 Wallstent and 10 × 40 mm SMART stent DH/3 mo* 74/M Thyroid CA, ND, XRT 1 Direct tumor involvement of CCA I 10 × 30 and 10 × 40 mm SMART stents DH/2.5 mo; deceased 1.5 yr* 72/M SCCa, ND, XRT 1 CCA luminal ulcer, mild stenosis, and irregularity II Two 8 × 40 mm SMART stents DH/1.5 mo* 75/M SCCa, XRT, ND 1 Psa (2) proximal ICA II 4 × 18 and 4 × 12 mm AVE stents rCBS/3 days 2 Increase in size of ICA Psa II Attempted vein-covered Palmaz stent; 6 × 20 and 7 × 20 mm Wallstents and GDCs DH/deceased 4 days as result of PE* Palmaz stent placed in R EIA 54/M SCCa, ND, XRT, rCBS 1 ICA Psa II Gortex covered Palmaz stent (P104) DH/3 mo 56/M SCCa, TLa, ND, XRT, Pc 1 CCA/ICA luminal irregularity and small Psa; ECA superior thyroidal irregularity and Psa III GDCs in ECA Psa; Two 8 × 40 mm Wallstents ICA/CCA DH/1.6 year 26/M SCCa, XRT, ND, rCBS 1 ICA luminal irregularity and stenosis; 2 Psa of ECA trunk III 4 × 16/4 × 9 mm NIR ON Ranger stents in ICA; GDCs in ECA trunk DH/deceased 1.5 mo* 66/F SCCa, XRT, ND 1 ICA Psa III 8 × 20 and 8 × 60 mm Wallstents rCBS/2 days 2 ICA Psa III DPAE under flow arrest DH/1 yr* TIA 46/M SCCa, ND, Pc 1 ICA Psa II Three overlap Precise stents rCBS/1 day 2 ICA Psa II 7 × 30 mm Wallgraft DH/1 mo* 41/F SCCa, TLa (Fig 2) ECA origin Psa II 8 × 30 mm Wallgraft DH/1 yr Note.—CBS indicates carotid blowout syndrome; M, male; F, female; SCCa, squamous cell carcinoma; ND, surgical neck dissection; XRT, radiation therapy; CA, cancer; rCBS, recurrent carotid blowout syndrome; TLa, total laryngectomy; Pc, pharyngocutaneous fistula; ICA, internal carotid artery; Psa, pseudoaneurysm; CCA, common carotid artery; ECA, external carotid artery; DH, durable hemostasis; PE, pulmonary embolus; R EIA, right external iliac artery; TIA, transient ischemia.
* Advanced head and neck cancer.
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