Carotid Artery Rupture Research Articles

Extracranial vertebral artery to middle cerebral artery bypass in therapeutic internal carotid artery occlusion for epipharyngeal carcinoma: A technical case report.

Background: Vertebral artery (VA) to middle cerebral artery (MCA) bypass is a rarely selected technique because a complex expanded dissection is required, and often, a better donor artery than VA exists. A good indication for VA-MCA bypass is the treatment of head-and-neck malignancies with the sacrifice of the internal carotid artery (ICA) or for carotid artery rupture.Methods: A 23-year-old man with epipharyngeal carcinoma, treated by ligating the carotid artery with a VAMCA bypass before chemoradiotherapy, was reported. Radiographic findings showed that the bone of the carotid canal was dissolved, and the right ICA was engulfed by the tumor. As epipharyngeal carcinoma is hypersensitive to radiation, in cases where the tumor rapidly disappears, ICA may dangle in the pharynx and rupture may occur. In addition, to irradiate sufficiently, the ICA may become an obstacle. Hence, we decided to perform carotid ligation with a VA-MCA bypass before radiation and chemotherapy for the primary lesion. We selected the V3 portion of the VA as the donor on the ipsilateral side, as it can supply high-flow cerebral blood flow, which is not influenced by carcinoma and less influenced by irradiation for the epipharynx.Results: The VA-MCA bypass was completed without complications followed by endovascular occlusion of the ICA. Induction chemotherapy was initiated for the patient 2 weeks after surgery. The patient achieved a complete response following chemoradiotherapy.Conclusion: ICA ligation with VA-MCA high-flow bypass earlier than chemoradiotherapy is useful for epipharyngeal carcinoma as it prevents carotid artery rupture and allows radical intervention.

Retrospective Analysis on Traumatic Rupture of Intracranial Internal Carotid Artery in 11 Cases.

Objective To retrospectively analyze the characteristics of the traumatic rupture of intracranial internal carotid artery in order to provide reference for forensic expertise examination and identification. Methods A total of 11 autopsy cases of traumatic rupture of intracranial internal carotid artery were collected. The gender, age, cause of injury, blood loss on the scene, location of internal carotid artery rupture, hardening degree of the rupture of the wall, brain injury, blood ethanol content and cause of death were also recorded. Results All 11 cases died on the scene, of which 7 died from traffic accidents, 2 falls from height and 2 from bare handed injuries. None of the 11 victims suffered serious head and body surface injury. The internal carotid artery rupture in the 9 cases of traffic injury and fall from height injury occurred in the cavernous segment. In all these cases, there were transverse fractures of the middle cranial fossa with the carotid sulcus involved, and minor intracranial hemorrhage and brain contusion. In 2 cases of bare handed injuries, internal carotid artery rupture occurred in the ophthalmic artery segment, accompanied by fatal intracranial hemorrhage and diffuse axonal injury, but no skull fracture. All 11 cases showed full-thickness rupture of the vessel wall, and the long axis of the wounds was perpendicular to those of the artery. Conclusion The incidence of intracranial internal carotid artery rupture in high-energy trauma events such as traffic accidents and high falls deserves attention. Injuries of the cavernous segment or ophthalmic segment might be more common. The main injury mechanism of intracranial internal carotid artery rupture might be that the blood vessels were pulled and the bone fragments caused damage.

Emergency interventional embolization for the management of intractable tumor bleeding in head and neck cancer

Objective: To evaluate emergency interventional embolization in treating intractable tumor bleeding in head and neck cancer. Methods: From February 2017 to February 2019, a total of 21 patients underwent emergency interventional embolization for the management of intractable tumor bleeding in head and neck cancer in Cancer Hospital, Chinese Academy of Medical Sciences. The tumor treatment history, bleeding history, angiography performance, technical success rate, clinical success rate and complications were retrospectively analyzed. Results: The positive rate of angiography was 100% (21/21). Selective angiogram revealing abnormal tumor staining in 11 cases, contrast media extravasation in 5 cases, pseudoaneurysm in 2 cases, arteriovenous malformation in 2 cases and external carotid artery rupture in 1 case. One patient with carotid rupture was transferred to a general hospital for treatment. The remaining 20 patients received a total of 22 times of interventional embolization. The technical success rate was 100% (22/22). Recurrence occurred in 4 patients within 30 days, and the clinical success rate was 80%(16/20). Mild maxillofacial pain occurred in 5 patients (25.0%) and no serious complications occurred. Conclusion: Emergency interventional embolization is safe and effective for the management of intractable tumor bleeding in head and neck cancer.

Clinical Analysis of Pectoralis Major Myocutaneous Flap for Reconstruction of Tissue Defects after Pharyngolaryngeal Cancer Surgery

Objective: To explore the methods and effects of pectoralis major myocutaneous flap in pharyngolaryngeal cancer surgery. Methods: Among 23 cases of pharyngolaryngeal cancer patients, the surgical procedure was based on pathologic conditions, and the surgical defects were repaired by pectoralis major myocutaneous flap. Results: Among 23 patients, there were 1 case of skin flap necrosis, 4 cases of pharyngeal fistula, 1 case of hypopharyngeal esophageal stenosis; except 1 case of pharyngeal fistula died of carotid artery rupture caused by infection, 1 case of hypopharyngeal esophageal stenosis required a gastric tube, and the rest patient’s swallowing function is normal. Conclusion: The blood supply of pectoralis major myocutaneous flap is reliable with the tissue volume enough for reconstruction. It turns out to improve patient survival and postoperative quality of life with the application of pharyngolaryngeal cancer surgery.

Lead to elevate the temperature and speed of emergency rescue and nursing care of common carotid artery rupture and massive hemorrhage after operation of typical esophageal cancer

Objective: Objective To explore the first aid and nursing of patients with anastomotic fistula after radical resection of esophagus carcinoma complicated with major carotid hemorrhage.Methods: The clinical data of anastomotic fistula complicated with carotid artery rupture and massive hemorrhage after radical resection of typical esophageal carcinoma were analyzed and summarized.Results:Through the close cooperation of medical care, the rescue was successful.Conclusion:Earlier prevention observation, raising first aid consciousness and actively cooperating with doctors can improve the success rate of rescue.

Sphenoid Wall Dehiscence: A Preventable Cause of Iatrogenic Internal Carotid Artery Rupture

Minimally Invasive approaches to pituitary tumor have become gold standard not just for pituitary surgery but also for pathologies of ventral skull base [1]. It is due to the fantastic view it offers and the ease of doing surgery. The same, however, are not without complications and rupture of Internal Carotid Artery (ICA) is potentially the most catastrophic and thus, most feared [2].

Internal carotid artery rupture successfully rescued after resection of locally advanced mucosal malignant melanoma of the eustachian tube: a case report

Mucosal melanoma of the eustachian tube is a rare and highly malignant tumour. Local radical resection combined with radiotherapy and systemic chemotherapy is a classic treatment strategy for this tumour. The internal carotid artery (ICA) is easily damaged when this tumour is removed. Once the ICA ruptures and causes haemorrhage, it can be fatal. We report a case of mucosal malignant melanoma of the eustachian tube with ICA rupture and haemorrhage in a 62-year-old woman 3 days after resection of the tumour. After successful emergency endotracheal intubation, anti-shock treatment was performed. Further, the ICA was examined using digital subtraction angiography under general anaesthesia and the bleeding site was embolized. The patient recovered uneventfully after surgery and was discharged from hospital without hemiplegia, aphasia, or other intracranial complications. Because of economic reasons, the patient discontinued comprehensive treatment after being discharged from the hospital. Finally, she developed bone and kidney metastases 8 months after surgery and died of distant metastases 1.5 years later. When removing eustachian tube lesions, the ICA must be particularly protected. Once the ICA ruptures and there is postoperative haemorrhage, prevention of airway asphyxia, timely anti-shock treatment, and emergency digital subtraction angiography and vascular embolization are effective treatment methods.

Neck stiffness after transoral pharyngolaryngeal surgery for squamous cell carcinoma

IntroductionPyogenic spondylodiscitis is a rare, destructive intervertebral disc infection. Case summaryWe describe a case of C2-C3 pyogenic spondylodiscitis after transoral surgery of the posterior pharyngeal wall in a 64-year-old man with a history of oropharyngeal squamous cell carcinoma (SCC) treated by neck irradiation (45Gy). Ten years after initial treatment, he underwent total laryngectomy for laryngeal SCC, together with transoral resection of carcinoma in situ (CIS) of the posterior pharyngeal wall followed by BioDesign® tissue repair graft. Five months later, C2-C3 spondylodiscitis was diagnosed with the formation of a fistula between the posterior pharyngeal wall and the intervertebral disc. Antibiotic therapy was administered for a total duration of 3 months (multi-susceptible Escherichia coli). Eight months after the diagnosis of spondylodiscitis, the patient died from carotid artery rupture following another course of radiotherapy for lymph node recurrence. DiscussionLarger-scale studies are necessary to evaluate the prevalence and risk factors of radiation-induced spondylodiscitis that currently remain poorly elucidated. The best treatment strategy (choice and duration of antibiotic therapy) and the optimal frequency of follow-up must be determined and the value of preventive measures (biomaterial, flap repair) needs to be evaluated.

Evaluation and embolization strategy by ASITN/SIR grade for injured internal carotid artery of nasopharyngeal carcinoma

Objective: To study the strategy of endovascular treatment for patients with the risks of internal carotid artery (ICA) rupture and bleeding during the treatment of nasopharyngeal carcinoma (NPC) based on American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grade of collateral circulation. Methods: A total of 56 patients (45 males and 11 females, aged from 28 to 76 years old) diagnosed with nasopharyngeal carcinoma and admitted to the Department of Neurosurgery, the Third Affiliated Hospital of Southern Medical University from July 2018 to January 2020 were retrospectively analyzed. There were 15 cases of ASITN/SIR grade 4, 24 cases of ASITN/SIR grade 3, 5 cases of ASITN/SIR grade 2, 5 cases of ASITN/SIR grade 1, and 7 cases of ASITN/SIR grade 0. The events of stroke and death were analyzed statistically. Results: ALL patients with ASITN/SIR grade 4 or 3 and some of patients with ASITN/SIR grades 2-0 passed balloon occlusion test and electrophysiological monitoring. ICA pseudoaneurysm was found in 35 patients, and one-stage ICA embolization was performed in 29 patients after evaluation. Among them, 8 cases of ASITN/SIR grade 4 and 10 cases of ASITN/SIR grade 3 with obvious posterior circulation compensation obtained successful one-stage ICA embolization without cerebral ischemia; cerebral ischemic events occurred in 5 (55.6%) of 9 patients with ASITN/SIR grade 3 and in 1(50.0%) of 2 patients with ASITN/SIR grade 2. The total incidence of ischemic events was 20.7% (6/29) and 1 case was disabled (1/29, 3.4%). Among patients with ASITN/SIR 3, there were statistically significant differences in stroke event rate between patients with obvious posterior circulation compensation and patients with slight or without posterior circulation compensation (0/10 vs. 5/9, χ(2)=4.95, P=0.026). Follow-up time was 10.1±7.8 months, and 46 patients were survival (46/56, 82.1%) and 10 patients died (10/56, 17.9%) with a mean survival time of 2.6±1.4 months. Conclusions: For NPC patients with ICA invasion, ASITN/SIR based on DSA can simplify the assessment process of cerebral blood flow compensation. ICA can be embolized directly in patients with ASITN/SIR 4 or 3 with obvious posterior communicating compensation.

Radiotherapy-induced Acute Carotid Blowout Syndrome in Base of Tongue Cancer

Carotid blowout syndrome is an uncommon and fatal medical emergency in patients with head and neck cancer. Tumor progression, previous surgery, and radiotherapy on the head and the neck regions are some of the predisposing factors that affect its presentation. An early suspicion of a carotid blowout syndrome allows early safety measurements to prevent catastrophic events. A 71-year-old man with advanced base of tongue cancer was presented with a self- limiting oral bleeding 18 months after receiving chemoradiotherapy. Fiberoptic laryngoscopy and contrast-enhanced computed tomography revealed the presence of edema of the hypopharynx and thyroid cartilage fracture and necrosis. The patient developed acute oral hemorrhage. Surgical intervention was insufficient to achieve hemostasis. The carotid angiography revealed a common carotid artery rupture, and a covered stent was placed endovascularly. The covered stent placement was enough to stop the bleeding. However, the patient died from perioperative complications. Experience is necessary for the early detection and prevention of a carotid blowout syndrome.

기관 절개술 중 발생한 경동맥 파열 1예

The authors report one case of carotid artery rupture in a 51-year-old woman, which occurred during a tracheostomy with successful treatment by bovine patch angioplasty. In order to avoid various complications of tracheostomy, risk factors such as obesity, short neck and bleeding tendency must be evaluated before tracheostomy. Elective tracheostomy by trainee might be better to be performed under general anesthesia with intubation during daytime when an experienced staff can help in emergency. During tracheostomy, continuous identification of midline trachea with palpation is crucial to avoid injuries in surrounding structures. (J Clinical Otolaryngol 2020;31:107-110)

Salvage of Failed Endovascular Management of Internal Carotid Artery Injury during Endoscopic Endonasal Pituitary Surgery

Rupture of Internal Carotid Artery (ICA) during trans-sphenoidal surgery can have high morbidity, as it results in altered mental status, stroke or cranial nerve palsies or is fatal for the patient as well. Hereby, Authors describe a case of 23-year-old female who underwent trans-sphenoidal surgery for recurrent pituitary macroadenoma. Removal of the pituitary tumour under general anaesthesia resulted in a bleeding pseudoaneurysm. Distal access catheter across the bleeding pseudoaneurysmal segment of right ICA was made and embolisation of the bleeding pseudoaneurysmal segment was done by placing stent graft. Then check angiogram was performed, which showed that significant embolisation was not achieved. Since, stent graft was unsuccessful to control bleeding, a decision was taken to perform neck dissection to clamp and control the ICA in the neck. Part of the procedure was to harvest a part of vastus lateralis muscle (1 cm × 0.5 cm), crushing it and mixing it with alternating layers of fibrin sealant. This mixture was put over the injured site for better clotting effect. The patient tolerated the procedure well, was shifted to the Intensive Care Unit and vitals were stable thereafter. There are very few instances in published literature which describe the repair of injured ICA using muscle and fibrin sealant. The present case highlights the importance of executing urgent and innovative techniques to control bleeding ICA.

Four rescued cases of carotid artery rupture related to recurrent head and neck cancer

Four rescued cases of carotid artery rupture related to recurrent head and neck cancer

Salvage surgery for structural local recurrence of papillary thyroid cancer: recurrence patterns and surgical outcome

To clarify the patterns of the recurrence and to assess the oncological and functional outcomes after salvage surgery for the patients with structural local recurrence of papillary thyroid cancer (PTC), twenty-five patients who underwent salvage surgery for structural local recurrence of PTC were retrospectively reviewed. Structural recurrences were observed in the tracheal lumen in 5 patients, intraluminal or intramuscular esophagus in 5 patients, trachea, and cricoid cartilage in 9 patients, cricoid and thyroid cartilage in 2 patients, intra-lumen of the larynx in 1 patient and soft tissue around thyroid in 3 patients, respectively. Although all local disease was resected with macroscopically negative margin, 10 patients diagnosed as microscopically positive margin. Major surgical complications occurred in 6 patients, including common carotid artery injury (n = 1), unintentional pharyngeal or esophageal injury (n = 2), recurrent laryngeal nerve paralysis (n = 2), and pharyngeal fistula resulting in common carotid artery rupture (n = 1), and were successfully managed. During the follow-up periods, 6 patients were alive without disease, 15 patients survived with distant metastases and/or locoregional recurrence, and 4 patients died of the disease. While tracheocutaneous fistula remained in 7 patients, the vocal function was preserved in all patients but one who underwent total laryngectomy. Normal oral intake was retained in all patients. In conclusion, although salvage surgery for structural recurrence of PTC has a high risk of complications, it may be worthwhile when macroscopic curative resection is available. The decision should be made considering various factors including curability, risk of surgical procedure, functional outcome, and life expectancy.

Pharyngocutaneous Fistula which Occurred During Postoperative Radiotherapy in Larynx Cancer Patient with Dementia

Pharyngocutaneous fistula is a relatively common, but serious complication after pharyngeal or laryngeal cancer surgery. It can cause wound infection, longer hospitalization period and sometimes carotid artery rupture which can be fatal. Recently, we experienced a 63-year-old larynx cancer patient who had dementia and alcoholic liver cirrhosis for underlying diseases. He underwent total laryngectomy and both neck dissection, and pharyngocutaneous fistula occurred during postoperative radiotherapy. Pharyngocutaneous fistula during postoperative radiotherapy has not yet reported in the literature, and there are few reports about pre and postoperative management of dementia patient after head and neck cancer surgery. Therefore, we report this case with a brief review of literature. Key Words: Pharyngocutaneous, Fistula, Radiotherapy, Dementia, Laryngectomy

Efficacy and Safety of Willis Covered Stent for Treatment of Complex Vascular Diseases of the Internal Carotid Artery

Willis covered stents are used in clinical practice for some complex cerebrovascular diseases. However, the performance of the Willis covered stent requires further investigation. In this study, we investigate the safety and efficacy of Willis covered stents for the treatment of complex vascular diseases of the internal carotid artery (ICA). Thirteen patients with complex ICA diseases treated with the Willis covered stent system at our institution from October 2016 to January 2018 were analyzed retrospectively. Follow-up observation and digital subtraction angiography (DSA) examination were conducted at about 6-10months after the treatment. The complex vascular diseases of the ICA were successfully treated in 12 patients. The technical success rate was 92.3%. Pathologically, 13 lesions included blood blister-like aneurysm (n=7), traumatic pseudoaneurysm (n=1), traumatic carotid artery rupture (n=1), and aneurysm with arteriovenous fistula (n=4). Thirteen patients with complex vascular diseases of the ICA were treated with 15 Willis covered stents. The release sites of Willis covered stents were the C7 (n=2), C6 (n=1), C5 and/or C4 (n=9), and the C2 (n=3) segment of the ICA. DSA performed immediately after stent deployment revealed that complete occlusion of the lesion was achieved in 11 patients and endoleak was observed in 2 patients. Of the 11 patients, postoperative DSA examination indicated that the lesions were occluded completely. Among 2 patients, who had a second stent implantation at the break of the ICA, the traumatic ICA rupture was essentially completely obstructed in 1 patient. The endoleak remained in 1 patient with carotid cavernous sinus fistula because the placement of the second stent system was difficult with his ICA tortuosity. No recurrence of aneurysms, hemorrhagia, and other lesions was observed, and the patients' parent arteries were patent without stenosis. No procedure-related complications or deaths occurred during follow-up. For the treatment of complex vascular diseases in the ICA, Willis covered stent implantation is safe and effective. However, longer follow-up, large-sample controlled studies, and multicenter studies are needed for further confirmation.

Nursing Performance Regarding Immediate Management of Carotid Artery Rupture

Background: Patients with head and neck cancer are in danger of creating carotid artery rupture that may cause life-threatening problems and death Aim: to assess the nursing performance regarding immediate management of carotid artery rupture. Study design: A descriptive research design was utilized in this study. Setting: The study was conducted in the critical care unit at south Egypt cancer institute at Assiut University hospital. Sample: A convenience sample of all available nurses (forty nurses) Tools: two tools were used for data collection, Nurses' knowledge assessment and observational checklist. Results: The majority of studied nurses (80%) were having an unsatisfactory level of knowledge regarding carotid artery rupture. Conclusion: Nurses` knowledge regarding carotid artery rupture and practice regarding immediate care of carotid artery rupture in critical care unit at south Egypt cancer institute at Assiut University hospital is unsatisfactory and have an inadequate level of knowledge and practice. Recommendation: Nurses need for in-service training programs to improve their knowledge and practice regarding the management of carotid artery rupture.

Blast injuries to carotid artery: development of a finite element model and biomechanical analysis

Objective To construct a three-dimensional finite element model to investigate the biomechanical mechanism of carotid blast injuries. Methods Based on the head and neck CT angiography data of a healthy male volunteer, the 3D geometric model was extracted by Mimics software. The 3D solid model was obtained by fitting the geometric model to the non-uniform rational B-splines (NURBS) by Geomagic Studio software. The mesh of blood vessels, blood and soft tissue was divided by HyperMesh software to obtain the three-dimensional finite element model of the carotid artery. The material parameters and boundary conditions were set, and the vessel wall rupture damage threshold was 1 MPa. The dynamic process of carotid injury caused by MK3A2 grenade explosion shock wave at the distance of 60, 70 and 80 cm to the neck was simulated using the LS-DYNA, generating the shock waveform and peak overpressure. The stress cloud map was used to analyze the stress distribution and damage morphology, and the stress curve was used to analyze the mechanical changes. Results The peak values of shock wave overpressure were 0.45, 0.63 and 0.96 MPa at the distance of 80, 70 and 60 cm away from the explosion center, respectively. At 80 cm, the peak stress of vessel wall was 0.43 MPa, and the vessel wall was not ruptured; at 70 cm, the peak stress of anonyma was greater than 1 MPa, which resulted in small rupture; at 60 cm, the peak stress of both anonyma the ascending aorta were greater than 1 MPa, leading to obvious rupture. The root part of the common carotid artery, anonyma and the arch of the aorta were high stress concentration areas, manifested as high-prevalence areas of damage and rupture. Conclusions The finite element model of explosive carotid artery injury is successfully constructed, which can be used to analyze the mechanical response and damage mechanism of carotid blast injuries. The main cause of injury and rupture is that the sudden change of stress in the process of explosion shock reaches or exceeds the threshold of vascular wall injury. Carotid artery rupture will occur when the vessel wall stress peak is greater than 1 MPa at 60 and 70 cm away from the explosion center, providing references for the clinical treatment and injury prevention. Key words: Carotid artery injuries; Shock wave; Finite element analysis; Biomechanics

Mediastinitis as complication of odontogenic infection: A case report

Odontogenic infections are one of the most common dental problems, which affect 80%-90% of the population. Untreated odontogenic infections can cause life-threatening complications such as necrotizing fasciitis, descending necrotizing mediastinitis, internal jugular vein thrombosis, cavernous sinus thrombosis, carotid artery pseudoaneurysm or rupture, and systemic inflammatory response syndrome. This report aims to present a mediastinitis case, in a 22-year-old healthy male patient, which originated from an odontogenic infection. The patient was hospitalized because of worsening general health status, despite the antibiotherapy. Computed tomography (CT) scan revealed that periapical abscess was spreading to the mediastinum through retropharyngeal space. The patient was successfully treated by IV antibiotherapy, transcervical drainage, and extraction of tooth.

Cartilaginous Eustachian tube length and carotid canal dehiscence in children: a radiological study.

The use of Balloon Eustachian tuboplasty (BET) for Eustachian tube dysfunction is increasing in adults but to a lesser extent in children. Despite growing experience, concerns remain that BET could theoretically cause carotid artery rupture, which may be more likely if there is carotid canal dehiscence adjacent to the bony Eustachian tube. This radiological study aims to assess the prevalence of carotid canal dehiscence and length of cartilaginous Eustachian tube in children. 75 consecutive computed tomography scans of the petrous temporal bones performed in children were identified (150 carotid canals/Eustachian tubes). Two independent raters measured the length of the cartilaginous Eustachian tube and thickness of carotid canal wall. 8% of carotid canals had radiological dehiscence. Prevalence of carotid canal dehiscence on either side per child was 12%. Mean cartilaginous Eustachian tube length was 24.5mm (SD 3.1mm) and the minimum measured was 14.1mm. The minimum length measured in a child over 3years old (n = 65) was 18.1mm. The mean thickness of bone of the carotid canal was 0.7mm (SD 0.27mm). There was a positive relationship between age and Eustachian tube length (Pearson's correlation coefficient = 0.622, p < 0.001). Carotid canal dehiscence in children has a low prevalence. Variation in the length of the cartilaginous Eustachian tube is low but is correlated with age. More research is required to define the indications, safety, efficacy and technical aspects of BET in children.