Journal of the Chinese Medical Association
Volume 73, Issue 5 , Pages 271-274, May 2010

Distal Marginal Stenosis: A Contributing Factor in Delayed Carotid Occlusion of a Patient With Carotid Blowout Syndrome Treated With Stent Grafts

Department of Radiology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Received 8 May 2009; accepted 10 March 2010.

Article Outline

Distal marginal stenosis is rarely reported to be a factor associated with poor long-term patency of patients of head and neck cancers with carotid blowout syndrome treated with stent grafts. We report a case of laryngeal cancer with rupture of the right common carotid artery. A self-expandable stent graft was deployed, but bleeding recurred. Another stent graft was deployed for the pseudoaneurysm located distal to the first stent graft. Rebleeding occurred because of pseudoaneurysm formation from reconstituted branches of the right superior thyroid artery. We performed direct percutaneous puncture of the proximal superior thyroid artery for successful embolization. Distal marginal stenosis and asymptomatic thrombosis of the carotid artery were noted at 3.5- and 5-month follow-ups, respectively. We suggest aggressive early follow-up and reintervention for distal marginal stenosis by combined antibiotic therapy and angioplasty and stenting to improve the long-term patency of stent-graft deployment for management of carotid blowout syndrome.

Key Words:  carotid blowout syndrome , distal marginal stenosis , stent graft

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References 

  1. Chaloupka JC , Putman CM , Citardi MJ , Ross DA , Sasaki CT . Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: diagnosis and managerial considerations . AJNR Am J Neuroradiol . 1996;17:843–852
  2. Macdonald S , Gan J , Mckay AJ , Edwards RD . Endovascular treatment of acute carotid blowout syndrome . J Vasc Interv Radiol . 2000;11:1184–1188
  3. Citardi MJ , Chaloupak JC , Son YH , Ariyan S , Sasaki CT . Management of carotid artery rupture by monitored endovas-cular therapeutic occlusion (1988-1994) . Laryngoscope . 1995;105:1086–1092
  4. Cohe J , Rad L . Contemporary management of carotid blowout . Curr Opin Otolaryngol Head Neck Surg . 2004;12:110–115
  5. Warren FM , Cohen JI , Nesbit GM , Barnwell SL , Wax MK , Andersen PE . Management of carotid “blowout” with endovascular stent grafts . Laryngoscope . 2002;112:428–433
  6. Lesley WS , Chaloupka JC , Weigele JB , Mangla S , Dogar MA . Preliminary experience with endovascular reconstruction for the management of carotid blowout syndrome . AJNR Am J Neuroradiol . 2003;24:975–981
  7. Chang FC, Lirng JF, Luo CB, Guo WY, Teng MMH, Tai SK, et al. Carotid blowout syndrome in patients with head-and-neck cancers: reconstructive management by self-expandable stent-grafts . AJNR Am J Neuroradiol . 2007;28:181–188
  8. Chang FC , Lirng JF , Tai SK , Luo CB , Teng MMH , Chang CY . Brain abscess formation: a delayed complication of carotid blowout syndrome treated by self-expandable stent-graft . AJNR Am J Neuroradiol . 2006;27:1543–1545
  9. Chang FC, Lirng JF, Luo CB, Wang SJ, Wu HM, Guo WY, et al  Patients with head and neck cancers and associated postirradiated carotid blowout syndrome: endovas-cular therapeutic methods and outcome . J Vasc Surg . 2008;47:936–945
  10. Tanaka N, Martin JB, Tokunaga K, Abe T, Uchivama Y, Hayabuchi N, et al  Conformity of carotid stents with vascular anatomy: evaluation in carotid models . AJNR Am J Neuroradiol . 2004;25:604–607
  11. Gercken U, Lansky AJ, Bullesfeld L, Desai K, Badereldin M, Mueller R, et al  Results of the Jostent coronary stent graft implantation in various clinical settings: procedural and follow-up results . Catheter Cardiovasc Intervent . 2002;56:353–360
  12. Latham JA , Irvine A . Infection of endovascular stents: an uncommon but important complication . Cardiovascular Surg . 1999;7:179–182

PII: S1726-4901(10)70059-9

doi:10.1016/S1726-4901(10)70059-9

Journal of the Chinese Medical Association
Volume 73, Issue 5 , Pages 271-274, May 2010

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