Carotid Stenting and “Extarterectomy” in the Management of Head and Neck Cancer Involving the Internal Carotid Artery: Technical Case Report

Neurosurgery ◽  
2000 ◽  
Vol 47 (4) ◽  
pp. 981-984 ◽  
Author(s):  
Eric S. Nussbaum ◽  
Samuel C. Levine ◽  
David Hamlar ◽  
Michael T. Madison
Keyword(s):  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Head And Neck ◽  
Neck Cancer ◽  
Internal Carotid ◽  
Tumor Resection ◽  
Collateral Flow ◽  
Flow Through ◽  
Aggressive Tumor

Abstract OBJECTIVE AND IMPORTANCE Head and neck cancer that invades the internal carotid artery (ICA) represents a significant management challenge. We describe a novel technique that allows for aggressive tumor removal without disrupting blood flow through the affected ICA. CLINICAL PRESENTATION A 62-year-old man was referred to our institution for management of a neck malignancy involving the ICA. Cerebral angiography suggested that there was good collateral flow from the opposite hemisphere, but the patient reported visual loss in the ipsilateral eye during balloon test occlusion of the ICA. INTERVENTION A self-expanding stent was deployed in the ICA; it spanned the entire length of the artery involved by tumor. One month later, the patient underwent tumor resection. During surgery, a long ICA arteriotomy was performed directly down to the mesh of the stent. A neoendothelium had formed within the stent, which prevented arterial bleeding. The carotid wall was dissected from the stent without difficulty and removed en bloc with the surrounding tumor. The exposed stent was wrapped circumferentially with a synthetic patch material. The patient tolerated the procedure well, and postoperative angiography demonstrated normal filling of the ICA. CONCLUSION We describe a novel approach to a patient with head and neck cancer involving the cervical ICA. Preliminary stenting, which allows time for endothelialization before surgery, may permit aggressive tumor resection without interrupting flow through the ICA. This technique obviates the need for complicated carotid reconstruction procedures and avoids the risk of delayed ischemia from carotid sacrifice.

Unknown internal carotid artery atherosclerotic stenoses detected with biphasic multidetector computed tomography for head and neck cancer

2005 ◽  
Vol 16 (4) ◽  
pp. 866-871 ◽  
Author(s):  
Nicola Flor ◽  
Francesco Sardanelli ◽  
Simone Soldi ◽  
Giuseppe Franceschelli ◽  
Caterina Missiroli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Head And Neck ◽  
Multidetector Computed Tomography ◽  
Neck Cancer ◽  
Internal Carotid

scholarly journals Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome

2020 ◽  
Vol 15 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Chi-Ju Lu ◽  
Yen-Heng Lin ◽  
Chung-Wei Lee
Keyword(s):  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Head And Neck ◽  
Neck Cancer ◽  
Internal Carotid ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Carotid Blowout Syndrome

Carotid blowout syndrome (CBS) is a fatal complication of head and neck cancer. Endovascular treatment, particularly deconstructive embolization, is effective for CBS, but it might result in thromboembolic events. We report the case of a 57-year-old man with underlying recurrent head and neck cancer who had CBS. The patient received endovascular embolization of the right internal, external, and common carotid arteries. Right internal carotid artery to middle cerebral artery embolic occlusion was noted immediately after the procedure, and left-sided weakness and facial palsy were found. Ipsilateral suprabulbar cervical internal carotid artery puncture was performed under fluoroscopic guidance, and rescue suction thrombectomy was successful. The patient had no significant neurological sequela. Transcarotid intraarterial thrombectomy is a reasonable method for managing postembolization large vessel occlusion, even in the neck, after irradiation.

Extracranial-intracranial Bypass for Reconstruction of Internal Carotid Artery in the Management of Head and Neck Cancer

2003 ◽  
Vol 17 (3) ◽  
pp. 260-265 ◽  
Author(s):  
Hideaki Chazono ◽  
Yoshitaka Okamoto ◽  
Zensei Matsuzaki ◽  
Jun Ogino ◽  
Shuichiro Endo ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Head And Neck ◽  
Neck Cancer ◽  
Internal Carotid

scholarly journals Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial–intracranial revascularization

2003 ◽  
Vol 14 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Iman Feiz-Erfan ◽  
Patrick P. Han ◽  
Robert F. Spetzler ◽  
Giuseppe Lanzino ◽  
Mauro A. T. Ferreira ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Head And Neck ◽  
Skull Base ◽  
Squamous Cell ◽  
Internal Carotid ◽  
Tumor Resection ◽  
High Rate ◽  
Neurological Deficits ◽  
Preoperative Imaging

Object Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable. Methods Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47–69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial–intracranial (EC–IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected. Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2–40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens. Conclusions A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC–IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.

Endovascular Management of Impending Carotid Rupture in a Patient with Advanced Head and Neck Cancer

2003 ◽  
Vol 10 (1) ◽  
pp. 54-57 ◽  
Author(s):  
Mark C. Bates ◽  
Fadi M. Shamsham
Keyword(s):  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Head And Neck ◽  
Stent Graft ◽  
Neck Cancer ◽  
Coil Embolization ◽  
Internal Carotid ◽  
External Carotid ◽  
Recurrent Bleeding ◽  
The Common

Purpose: To describe an innovative endovascular technique combining a flexible self-expanding stent-graft to protect the common and internal carotid artery with selective coil embolization of the affected external carotid artery (ECA) branches. Case Report: A 42-year-old man presented with episodes of profuse but self-limited carotid hemorrhage from advanced squamous cell carcinoma of the neck. Despite invasion of the carotid sheath by the tumor, angiography confirmed the source of bleeding to be invasion of branches of the ECA. Successful coil embolization of the ECA and stent-graft isolation of the common/internal carotid arteries were performed. At 1-month follow-up, carotid angiography confirmed the complete occlusion of the ECA and patent stent-graft. There was no recurrent bleeding or neurological deficits at 6 months after the procedure. Conclusions: Stent-grafts in combination with coil embolization can be used to manage patients with impending carotid rupture secondary to head and neck cancer.

scholarly journals Long-Term Results of Carotid Artery Stenting in Veterans With Prior Head and Neck Cancer

2017 ◽  
Vol 66 (4) ◽  
pp. e91-e92
Author(s):  
Roy W. Jones ◽  
Adam Tanious ◽  
Paul Armstrong ◽  
Neil Moudgill ◽  
Karl A. Illig ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Head And Neck ◽  
Neck Cancer ◽  
Carotid Artery Stenting ◽  
Long Term Results

scholarly journals Preoperative Embolization of Brain Tumor with Pial Artery or Dural Branch of Internal Carotid Artery as Feeding Artery

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 246-251 ◽  
Author(s):  
M Hirohata ◽  
T Abe ◽  
N Fujimura ◽  
Y Takeuchi ◽  
M Shigemori
Keyword(s):  
Brain Tumor ◽  
Carotid Artery ◽  
Blood Loss ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Tumor Resection ◽  
Preoperative Embolization ◽  
Digital Subtraction ◽  
Feeding Artery ◽  
Pial Artery

This study evaluated the clinical usefulness of preoperative embolization of the pial artery or dural branch of the internal carotid artery (ICA) for brain tumor. Subjects comprised 17 patients with large hypervascular brain tumors who underwent preoperative selective embolization. Micro-catheters (2- or 1.7-F) and shapeable hydrophilic micro-guide wires were used for pial artery (branching from the posterior or anterior cerebral artery) or ICA dural branch embolization. Embolization was performed under digital subtraction fluoroscopy with Polyvinyl alcohol (PVA) particles (150–250 mm) and/or liquid coil. Tumor resection was performed immediately or the day after embolization. Digital subtraction angiography (DSA) before and after endovascular devascularization, blood loss during tumor resection, and clinical outcome were evaluated. All endovascular procedures were technically successful. Post-embolization DSA revealed either a disappearance or a marked decrease of the tumor stain in all cases. Control of intraoperative bleeding was easily accomplished, and intraoperative blood loss was low. Preoperative particle embolization of the feeding artery from the cortical artery or ICA dural branch is safe and effective as adjuvant therapy before tumor resection.

Embolic stroke after carotid artery ligation during carotid body tumor resection

Vascular ◽  
2011 ◽  
Vol 21 (1) ◽  
pp. 23-26
Author(s):  
Hyangkyoung Kim ◽  
Yong-Pil Cho ◽  
Ki-Myung Moon ◽  
Tae-Won Kwon
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Body ◽  
Internal Carotid ◽  
Tumor Resection ◽  
Antiplatelet Agents ◽  
Carotid Body Tumor ◽  
Tumor Surgery ◽  
Artery Ligation ◽  
Carotid Artery Ligation

This report describes a case of a delayed cerebral embolic infarction, after internal carotid artery (ICA) ligation secondary to carotid body tumor resection. We describe a 34-year-old woman who underwent left ICA ligation during a large carotid body tumor surgery. Immediately after surgery, the patient was neurologically asymptomatic; however, she subsequently developed a cerebral embolic infarction nine hours postoperatively. After beginning antiplatelet therapy, all symptoms ultimately resolved, although over a gradual course. Since the ligation of the ICA can cause thromboembolic infarctions of the cerebrum, we contend that antiplatelet agents be administered to prevent and/or treat embolic strokes.

scholarly journals Rupture of carotid artery pseudoaneurysm in the modern era of definitive chemoradiation for head and neck cancer: Two case reports

2020 ◽  
Vol 8 (20) ◽  
pp. 4858-4865
Author(s):  
Myungsoo Kim ◽  
Ji Hyung Hong ◽  
Sang Kyu Park ◽  
Sook Jung Kim ◽  
Jung Hwi Lee ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Head And Neck ◽  
Neck Cancer ◽  
Case Reports ◽  
Artery Pseudoaneurysm ◽  
Definitive Chemoradiation ◽  
Modern Era

Abstract WP150: BeamSAT MRI Help to Identify Patients at Risk for Intolerance to Temporary Internal Carotid Artery Occlusion During CEA and CAS

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jun Tanaka ◽  
Kohkichi Hosoda ◽  
Yusuke Yamamoto ◽  
Taichiro Imahori ◽  
Atsushi Fujita ◽  
...  
Keyword(s):  
At Risk ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Preoperative Assessment ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Collateral Flow ◽  
Patients At Risk

Introduction: Pencil Beam type presaturation (BeamSAT) pulse on a major cervical vessel enables selective suppression of blood flow signal of the applied vessel in MR angiography (MRA). By subtracting the BeamSAT pulse-added MRA of an internal carotid artery (ICA) from conventional MRA, only the contralateral ICA image (SubBeamSAT image) can be obtained (Figure A, B). In this way, an ICA-selective MRA with more physiologial flow pattern can be obtained, because it requires no powerful injection of contrast medium. Purpose: The aim of this study was to investigate whether preoperative assessment of the flow of Acom/A1 by SubBeamSAT image and posterior communicating artery (Pcom) by conventional MRA could identify patients at risk for intolerance to intraoperative temporary ICA occlusion. Method: 29 patients who underwent carotid endarterectomy (CEA) (n = 17) or carotid artery stenting (CAS) (n = 12) were enrolled in the current study. All patients underwent the SubBeamSAT images and conventional MRA pre- and post-operatively. Response to ICA temporally occlusion was recorded during the revascularization procedure. Results: Among twenty-nine patients, 4 patients who demonstrate neither the Acom/A1 flow on SubBeamSAT image (Figure. B) nor Pcom flow on MRA showed intolerance. In contrast, the remaining 25 patients who demonstrated Acom/A1 (Figure. A) and/or Pcom flow showed tolerance. Intolerance to ICA occlusion was excellently predicted by visualization of collateral flow via Acom and Pcom (specificity: 100%, sensitivity: 100%, p=0.00004). Conclusions: SubBeamSAT image is useful for evaluating the flow of Acom from A1 portion of the healthy side to A2 portion of the contralateral side, which is often difficult to evaluate with conventional MRA. With the SubBeamSAT image, it is feasible to evaluate the Acom/A1 flow accurately. In conclusion, SubBeamSAT image enables excellent prediction for the intolerance to temporary ICA occlusion.

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