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      Procedure-Induced Acute Common Carotid Artery Perforation Presenting With Airway Obstruction and Successful Treatment by Endovascular Stent Graft

      case-report

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          Abstract

          A 63-year-old female was admitted to our hospital for catheter ablation during atrial fibrillation. After catheter ablation, the patient was transferred to the cardiac care unit and mechanically ventilated due to dyspnea and hypotension. Imaging showed active bleeding from the right common carotid artery (CCA) with extensive hematoma into the mediastinum. She was successfully treated with a stent graft at the CCA. Further bleeding or neurologic sequel did not occur after treatment.

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          Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy.

          David J Patton, G Minard, Carlo Croce … (1996)
          The incidence, associated injury pattern, diagnostic factors, risk for adverse outcome, and efficacy of anticoagulant therapy in the setting of blunt and carotid injury (BCI) were evaluated. Blunt carotid injury is considered uncommon. The authors believe that it is underdiagnosed. Outcome is thought to be compromised by diagnostic delay. If delay in diagnosis is important, it is implied that therapy is effective. Although anticoagulation is the most frequently used therapy, efficacy has not been proven. Patients with BCI were identified from the registry of a level I trauma center during an 11-year period (ending September 1995). Neurologic examinations and outcomes, brain computed tomography (CT) results, angiographic findings, risk factors, and heparin therapy were evaluated. Sixty-seven patients with 87 BCIs were treated. Thirty-four percent were diagnosed by incompatible neurologic and CT findings, 43% by new onset of neurologic deficits, and 23% by physical examination (neck injury, Horner's syndrome). There were 54 intimal dissections, 11 pseudoaneurysms, 17 thromboses, 4 carotid cavernous fistulas, and 1 transected internal carotid artery. Thirty-nine patients had follow-up angiograms. Mortality rate was 31%. Of 46 survivors, 63% had good neurologic outcomes, 17% moderate, and 20% bad. Logistic regression analysis demonstrated heparin therapy to be associated independently with survival (p < 0.02) and improvement in neurologic outcome (p < 0.01). Blunt carotid injury is more common than appreciated, seen in 0.67% of patients admitted after motor vehicle accidents. Therapy with heparin is highly efficacious, significantly reducing neurologic morbidity and mortality. Heparin therapy, when instituted before onset of symptoms, ameliorates neurologic deterioration. Liberal screening, leading to earlier diagnosis, would improve outcome.
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            Arterial injuries in transsphenoidal surgery for pituitary adenoma; the role of angiography and endovascular treatment.

            Olivier Hardy, R Czepko, D. Roy … (1997)
            To define the role of angiography and embolization in the treatment of patients who have arterial injuries during transsphenoidal surgery. We retrospectively studied the arterial hemorrhagic complications, their management, and the clinical outcomes that occurred in 21 of the more than 1800 patients who had transsphenoidal surgery for pituitary adenomas. Of the 21 patients who had complications, 17 had internal carotid injuries and four had injuries of the sphenopalatine artery. Angiography was performed in 18 patients. Bleeding occurred and was controlled during surgery in 16 cases. Delayed epistaxis occurred in 10 patients, including five whose surgery was uneventful. After internal carotid injury, the most frequent angiographic findings were carotid occlusion (eight patients), stenosis (five patients), and false aneurysms (three patients). Internal carotid balloon occlusion was performed in five patients. No rebleeding occurred in patients who had complete carotid occlusion either from surgical packing or balloon embolization. Two of the patients who had carotid stenosis after surgical packing had delayed epistaxis necessitating balloon occlusion. Injuries to the sphenopalatine artery were successfully treated by surgery (one patient) or by endovascular treatment (three patients) without complication. Three deaths and five permanent deficits were directly related to the arterial injury or its treatment. Profuse bleeding during and after transsphenoidal surgery should be investigated by angiography. Lesions of the sphenopalatine arteries are effectively treated by embolization. Internal carotid injuries are best treated by carotid infusion to prevent life-threatening epistaxis.
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              Covered stent-graft treatment of traumatic internal carotid artery pseudoaneurysms: a review.

              Dimitrios Maras, Christos Lioupis, George Magoufis … (2015)
              To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures. We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case. We identified 20 patients with traumatic extracranial ICA pseudoaneurysms due to penetrating craniocervical injuries or skull base fractures who had been treated with covered stent-graft implantation. Many discrepancies have been ascertained regarding the anticoagulation therapy. In 3 patients the ICA was totally occluded in the follow-up period, giving an overall occlusion rate 15%. No serious complication was reported as a result of the endovascular procedure. Preliminary results suggest that placement of stent-grafts is a safe and effective method of treating ICA traumatic pseudoaneurysms resulting from penetrating craniocervical injuries or skull base fractures. The immediate results are satisfactory when the procedure takes place with appropriate anticoagulation therapy. The periprocedural morbidity and mortality and the early patency are also acceptable. A surveillance program with appropriate interventions to manage restenosis may improve the long-term patency.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean Circ J
                Journal ID (publisher-id): KCJ
                Title: Korean Circulation Journal
                Publisher: The Korean Society of Cardiology
                ISSN (Print): 1738-5520
                ISSN (Electronic): 1738-5555
                Publication date (Print): July 2011
                Publication date (Electronic): 30 July 2011
                Volume: 41
                Issue: 7
                Pages: 405-408
                Affiliations
                Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
                Author notes
                Correspondence: Seung-Jung Park, MD, Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Tel: 82-2-3010-3152, Fax: 82-2-486-5918, sjpark@ 123456amc.seoul.kr
                Article
                DOI: 10.4070/kcj.2011.41.7.405
                PMC ID: 3152737
                PubMed ID: 21860644
                SO-VID: 5a91a8ae-158b-4a27-a34f-aadd577d9a0c
                Copyright © Copyright © 2011 The Korean Society of Cardiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 February 2011
                Date accepted : 14 March 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: carotid artery common,endovascular procedure,stents
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: carotid artery common, endovascular procedure, stents

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