Carotid body tumor resection utilizing a covered stent graft to enable resection of the tumor en bloc with the internal carotid artery

Abstract

Surgical excision is the primary treatment for carotid body tumors (CBT) and infrequently involves carotid vessels reconstruction. A CBT that extends distally to the level of the skull base makes surgical reconstruction very challenging. We report a case of a 30-year-old man who presented with a CBT (Shamblin III) extending to the base of the skull. A covered stent graft was placed in the internal carotid artery. Subsequently, a successful resection of the tumor with the arterial wall en bloc was performed, leaving the stent graft exposed as a bridge between the two ends of ICA.

Superselective carotid body tumor embolization with platinum-based coils

“… 25 , 27 This greater control can enhance precision of deployment and may mitigate the need for ECA sacrifice at the time of embolization. 3 The precision of our coil placement was underscored by coils discovered in ligated tumor-feeding vessels during open resection.…”

“…In the existing literature, coils have been primarily used in cases involving ECA sacrifice, instead of superselective catherization and embolization of individual feeding branches. 3 , 25 , 26 Previous reports of coil embolization have typically described coil placement in larger named arteries such as the ECA itself to occlude the entire vascular region supplying the tumor. Superselective microcatheterization of individual feeding branches has rarely been attempted in coil embolization techniques.…”

“… 2 Commonly used embolotherapeutic techniques in this particular clinical area have been associated with nontarget embolization leading to stroke, difficulty in catheterization of tumor-feeding vessels, and inflammatory reactions causing neovascularization. 3 , 4 Most agents currently used require surgical intervention within 24 to 48 hours after embolization to minimize revascularization of the tumor and the postembolization fibroinflammatory changes that can further complicate surgical excision. We, herein, demonstrate that prophylactic superselective CBT embolization with mechanically detachable, platinum-based coils adequately addresses safety concerns of embolization with preservation of the external carotid artery (ECA) main trunk; provides durable tumor devascularization foregoing the need for immediate postembolization excision, eliminates postembolization fibroinflammatory reactions, and may minimize intraoperative blood loss.…”

The Comparative Outcomes of Particulate Versus Coil Preoperative Embolization for Carotid Body Tumors

“…Multiple materials can be used for preoperative embolization, such as gelatin microspheres, nonspherical polyvinyl alcohol particles, coils, Onyx and gelfoam ( 10 , 18 – 21 ). Some researchers even implanted covered stents into the external or internal carotid artery for preoperative embolization and proved the efficacy ( 8 , 9 ). Although these materials can be adequate for devascularization of CBTs, complete embolization of the feeding artery is usually difficult to achieve.…”

Long-Term Surgical Outcomes of Carotid Body Tumors With Pathological Fibrosis: A Cohort Study

“…Prudent preoperative planning, particularly in patients with prominent pathological fibrosis or Shamblin class II and III CBTs, may avoid inadvertent ICA manipulation and bleeding. Pre-operative ECA embolization or ICA/CCA coverage with stent grafts have been proposed to reduce bleeding ( 17 , 21 ). We preferred early ECA division during the operation in patients with prominent fibrosis or class II and III tumors, which was more effective than preoperative percutaneous embolization for reducing stroke rate ( 14 ).…”