Endovascular Treatment for carotid blowout syndrome after radiation for esophageal cancer: A case report

Shigefumi Takahashi, Tomohiro Kawaguchi, Kuniyasu Nhzuma, Atsuhiro Nakagawa, Miki Fujimura, Takenori Ogawa, Yukio Katori, Teiji Tominaga

Research output: Contribution to journalArticlepeer-review

Abstract

Here, we discuss a case of carotid blowout syndrome successfully treated with endovascular parent artery occlusion. A 71-year-old woman underwent treatment for esophageal cancer resection, followed by 50-Gy radiotherapy. 19 years prior. Due to local recurrence, she underwent 66- and 72-Gy radiation treatments at 2 and 4 years after the initial treatment, respectively. Afterward, tracheostomy and enterostomy were performed. This time, she was transported to our emergency department because of acute eruptive bleeding from the tracheal tube. As her vitals indicated shock, emergency endovascular treatment was performed. Digital subtraction angiography revealed that the common carotid artery in the left-sided of the neck had a pseudoaneurysm extruding to the pharyngeal cavity, which was considered to be the lesion responsible for the acute rupture. She was diagnosed as having carotid blowout syndrome. Balloon test occlusion showed that the cross flow via the anterior and posterior communicating arteries was sufficient, so parent artery occlusion was chosen for bleeding control. Carotid bifurcation was preserved to keep the collateral circulation via the external carotid artery. The patient was discharged 22 days after treatment, without any neurological deficits. Although injured vessel removal with high-flow bypass was an ideal treatment to achieve bleeding control without ischemic complication, endovascular treatment can be an efficient second-best treatment. To minimize the risk of late ischemic complications, flow preservation via carotid bifurcation might be important.

Original languageEnglish
Pages (from-to)791-798
Number of pages8
JournalNeurological Surgery
Volume45
Issue number9
Publication statusPublished - 2017 Sep

Keywords

  • Carotid blowout syndrome
  • Collateral circulation
  • Endovascular treatment
  • Pseudoaneurysm
  • Radiation overdose

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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