Covered Carotid Stents as an Adjunct in the Surgical Treatment of Carotid Body Tumors

Abstract

Carotid body tumors are a technically challenging surgical problem. One of the primary goals of surgery and often one of the most difficult aspects of management involves preservation of the ipsilateral internal carotid artery (ICA). We report a small case series with challenging aspects to ICA preservation that were successfully treated with covered stenting and review the literature to date on this topic. Two patients with carotid body tumors were selected for covered ICA stenting, the first because of bilateral disease and the second because of failure of test occlusion. The patients were initially loaded with antiplatelet agents, and the stents were deployed transfemorally. The patients were kept on dual therapy (acetylsalicylic acid and Plavix) for 6 weeks, followed by acetylsalicylic acid alone, which was discontinued 1 week before surgery. The patients were admitted 3 days before surgery, and intravenous heparin was started and then stopped 6 hours preoperatively. Both tumors were completely resected with minimal blood loss, and the ipsilateral ICA was successfully preserved in both cases. The covered ICA stent offers a significant adjunct for preserving the ICA in carotid body tumor resection.