Rupture of an Internal Carotid Artery Pseudoaneurysm after Irradiation for a Nasopharyngeal Carcinoma -Case Report-

Hanada, Yukiko; Sasai, Hisanori; Kamakura, Aya; Nakamura, Megumi; Sakata, Yoshiharu; Miyata, Hiroshi

doi:10.3950/jibiinkoka.116.606

Cited by 14 publications

(5 citation statements)

References 8 publications

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“…[ 15 , 19 ] Other reported causes include infections, granulomatous diseases, connective tissue disorders, iatrogenic aneurysms, and radiation therapy. [ 4 , 12 , 19 ] In atherosclerosis, the initial damage to the internal elastic lamina is accompanied by subsequent intimal proliferation. Further, angiogenesis occurs within the thickened intima, leading to intramural hemorrhage leading to aneurysmal changes.…”

Section: Discussionmentioning

confidence: 99%

“…[ 13 ] The underlying pathology of EICA formation has been reported to be atherosclerosis (in >75% of cases), trauma, infection, and many other less common causes. [ 1 , 4 , 20 , 23 ] Although aneurysms may remain silent, EICAs become symptomatic more frequently than intracranial aneurysms. Cerebral ischemia (transitory ischemic attack or stroke) occurs in approximately 40% of patients, and local symptoms develop in approximately half of these patients.…”

Section: Introductionmentioning

confidence: 99%

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A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note

Hashio,

Sato,

Lepić

et al. 2024

Surgical Neurology International

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Background: Surgery is effective for extracranial internal carotid artery (EICA) aneurysms. However, the risk of cranial nerve injury associated with surgical repair, such as graft-assisted resection and extracranial-intracranial bypass techniques, is relatively high. Here, we report two cases of surgical treatment for EICA aneurysms and describe the surgical techniques and strategies to avoid cranial nerve injury. Methods: Two patients presented to our facility with an increasing cervical pulsatile mass and no neurological symptoms. Angiography showed a large aneurysm in the cervical internal carotid artery. Surgical treatment was performed to prevent rupture of the aneurysm. In both patients, the aneurysm was strongly attached to the vagus nerve. The aneurysm and vagus nerve were carefully dissected using a low-power bipolar (20 Malis; 3 watts), leaving connective tissue on the vagus nerve side. Results: The aneurysm was detached from the vagus nerve without injury. Based on intraoperative findings, one patient underwent clipping, and the other underwent aneurysmectomy and primary closure for aneurysm obliteration and angioplasty. Both patients were discharged without any cranial nerve dysfunction. Conclusion: The selection of a strategy based on intraoperative findings and low-power bipolar cutting is important for the treatment of extracranial carotid artery aneurysms to preserve cranial nerves.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note

Hashio,

Sato,

Lepić

et al. 2024

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…Active extravasation into the upper aerodigestive tract is a potentially life-threatening complication in patients with treated or recurrent head and neck cancers. Existing literature is limited to case reports and focuses on its treatment and management rather than imaging diagnosis [3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Active upper aerodigestive tract hemorrhage in patients with head and neck cancers: the “dot-in-sludge” sign

et al. 2023

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Active extravasation into the upper aerodigestive tract is a dramatic and potentially life-threatening complication in patients with head and neck cancers. It prompts presentation to the emergency room and subsequent urgent imaging to identify the source of hemorrhage. Imaging of these patients may be complicated by treatment-altered anatomy, posing a challenge to the emergency radiologist who needs to rapidly identify the presence of active hemorrhage and the potential source vessel. This retrospective review summarizes the clinical and imaging findings of 6 oropharyngeal and oral cavity squamous cell cancer (SCC) patients with active upper aerodigestive tract hemorrhage. Most patients had advanced stage disease and prior radiation therapy. All CECT or CTA exams on presentation demonstrated the “dot-in-sludge” sign of active extravasation, as demonstrated by a “dot” of avidly enhancing extravasated contrast material layered against a background “sludge” of non-enhancing debris in the lumen of the upper aerodigestive tract. Common sources of hemorrhage included the lingual, facial, and superior thyroidal arteries. Familiarity with these findings will help radiologists increase their accuracy and confidence in interpreting these urgent, complex examinations.

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“…This usually occurs in the petrous and lacerum segments of the ICA and may present with life-threatening epistaxis. Therefore, it is a major post-treatment complication of NPC[ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer: A case report

Park¹,

Jang²

2022

WJCC

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BACKGROUND Radiation therapy (RT) for nasopharyngeal cancer can cause several complications. In rare cases, an internal carotid artery pseudoaneurysm can occur, which can be fatal. We report the experience of a nasopharyngeal cancer patient who underwent radiation therapy and subsequently developed a fatal pseudoaneurysm of the petrous internal carotid artery. CASE SUMMARY A 39-year-old man was diagnosed with nasopharyngeal cancer 2 years ago (American Joint Committee on Cancer Stage T3N2M0) and received concurrent chemoradiation therapy. He subsequently relapsed and received chemotherapy. One week after the 4th cycle of chemotherapy, he was admitted to the emergency room of our hospital because of massive epistaxis accompanied by a headache. A pseudoaneurysm of the petrous internal carotid artery was confirmed by digital subtraction angiography (DSA). Stent-assisted endovascular coil embolization was performed and complete occlusion was achieved. No pseudoaneurysm was observed on DSA after coil embolization; however, intermittent epistaxis was maintained even after coil embolization. After seven days, a diagnostic laryngoscopy was performed. Massive bleeding occurred after aspiration of the blood clot during the laryngoscopy and the patient died of hypovolemic shock. In this case, epistaxis may have been a sign of pseudoaneurysm; therefore, treatment such as embolization should be performed promptly, and careful management should be undertaken after treatment. CONCLUSION This case highlights a rare, serious complication of RT in nasopharyngeal cancer and how it should be recognized and treated.

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Rupture of an Internal Carotid Artery Pseudoaneurysm after Irradiation for a Nasopharyngeal Carcinoma -Case Report-

Cited by 14 publications

References 8 publications

A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note

A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note

Active upper aerodigestive tract hemorrhage in patients with head and neck cancers: the “dot-in-sludge” sign

Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer: A case report

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