J Neurocrit Care.  2020 Dec;13(2):115-118. 10.18700/jnc.200026.

Endovascular treatment for pseudoaneurysm after carotid blowout syndrome

• Chung CH
• Roh YN
• Lee SH
• Jeong YS
• Hong JH
• Sohn SI
• Park H

• KMID: 2509942
• DOI: http://doi.org/10.18700/jnc.200026

Abstract

Background
Pseudoaneurysms of the carotid artery are rare and can be both a cause and consequence of carotid blowout syndrome (CBS) in patients with head and neck cancer. Surgical or endovascular treatment approaches may be useful for managing this condition.
Case Report
A 55-year-old man presented with a pulsatile mass surrounding the carotid bifurcation in the neck. He reported a history of CBS that occurred as a surgical complication while removing a benign neck cyst. Additionally, he reported a history of laryngeal cancer that underwent complete remission after surgery and radiotherapy. The mass was diagnosed as a pseudoaneurysm. Surgical treatment proved challenging owing to the patient’s history of neck surgery and radiotherapy; therefore, stent-graft deployment was performed and the absence of pulsations was checked through the neck mass.
Conclusion
Endovascular treatment may be a useful therapeutic strategy in cases of post-CBS pseudoaneurysm in patients undergoing surgery and/or radiotherapy for head and neck cancer.

Keyword

Aneurysm; False; Carotid artery injuries; Stents

Figure

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  Fig. 1. (A, B) Cortical and border-zone infarctions in the left cerebral hemisphere. (C) Multifocal long-segment stenosis of the left common carotid artery extending to the proximal internal carotid artery on computed tomography angiography. (D) A pulsating mass in the vicinity of the previous injury site of the carotid artery (red arrow). (E) Pseudoaneurysm immediately beneath the skin (white arrow). (F) Pseudoaneurysm (black arrow) with long-segment stenosis of the left common carotid artery on digital subtraction angiogram. (G) Non-visualization of pseudoaneurysm after deployment of a self-expandable stent graft. (H) The disappearance of the pseudoaneurysm with good stent patency on computed tomography angiogram 7 days after endovascular treatment. (I) The disappearance of the pulsatile mass in the vicinity of the previous injury site of the carotid artery (red arrowhead) after 3 months.

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