Endovascular Therapy for a Post-irradiated Cervical Pseudoaneurysm at the Carotid Stump: A Case Report

A nearly 80-year-old man with a history of radiotherapy (RT) and total laryngectomy for laryngeal cancer 25 years previously presented with a rapidly growing mass on the right side of his neck. A huge pseudoaneurysm (pseudoAN) was detected at the right carotid bifurcation, though angiography performed four years previously had shown total occlusion of the internal carotid artery. Stent-assisted coil embolization enabled aneurysm sac shrinkage. Clinicians must be aware that the stump of an arterial occlusion associated with RT can change into a pseudoAN over the long term and must provide follow-up in such cases.

[1]  U. Duvvuri,et al.  Outcomes of interventions for carotid blowout syndrome in patients with head and neck cancer. , 2016, Journal of vascular surgery.

[2]  P. Courtheoux,et al.  GREAT—a randomized controlled trial comparing HydroSoft/HydroFrame and bare platinum coils for endovascular aneurysm treatment: procedural safety and core-lab-assessedangiographic results , 2016, Neuroradiology.

[3]  J. Lirng,et al.  Endovascular Management of Post-Irradiated Carotid Blowout Syndrome , 2015, PloS one.

[4]  S. Walsh,et al.  Effects of Neck Radiation Therapy on Extra-Cranial Carotid Arteries Atherosclerosis Disease Prevalence: Systematic Review and a Meta-Analysis , 2014, PloS one.

[5]  G. Leung,et al.  Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device , 2014, Journal of NeuroInterventional Surgery.

[6]  T. Padhya,et al.  Rare treatment of radiation induced carotid pseudoaneurysm and ensuing carotid blowout syndrome with placement of multiple contiguous endovascular stents: a case report. , 2013, American journal of otolaryngology.

[7]  J. Wardlaw,et al.  Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial , 2011, The Lancet.

[8]  C. Majoie,et al.  Partially Thrombosed Intracranial Aneurysms Presenting with Mass Effect: Long-Term Clinical and Imaging Follow-Up after Endovascular Treatment , 2010, American Journal of Neuroradiology.

[9]  D. J. Ellens,et al.  Radiotherapy-induced common carotid pseudoaneurysm presenting with initially occult upper airway hemorrhage and successfully treated by endovascular stent graft. , 2010, American journal of otolaryngology.

[10]  T. Yoshizaki,et al.  Case of three delayed complications of radiotherapy: bilateral vocal cord immobility, esophageal obstruction and ruptured pseudoaneurysm of carotid artery. , 2009, Auris, nasus, larynx.

[11]  W. Kuo,et al.  Rupture of radiation‐induced internal carotid artery pseudoaneurysm in a patient with nasopharyngeal carcinoma—Spontaneous occlusion of carotid artery due to long‐term embolizing performance , 2008, Head & neck.

[12]  O. Abayomi.  Neck irradiation, carotid injury and its consequences. , 2004, Oral oncology.

[13]  Stephen W. K. Cheng,et al.  Accelerated progression of carotid stenosis in patients with previous external neck irradiation. , 2004, Journal of vascular surgery.

[14]  H. Strander,et al.  A Systematic Overview of Radiation Therapy Effects in Head and Neck Cancer , 2003, Acta oncologica.

[15]  L. Grandinetti,et al.  Endovascular repair of radiation-induced bilateral common carotid artery stenosis and pseudoaneurysms: a case report. , 2001, Surgical neurology.

[16]  H. Girishkumar,et al.  Pseudo-aneurysm of the carotid bifurcation secondary to radiation. , 1999, The Journal of cardiovascular surgery.

[17]  B. Baxter,et al.  Pseudoaneurysm of the External Carotid Artery following Radical Neck Dissection and Irradiation: A Case Report and Review of the Literature , 1994, Cardiovascular surgery.

[18]  E. Fonkalsrud,et al.  Serial changes in arterial structure following radiation therapy. , 1977, Surgery, gynecology & obstetrics.

[19]  G. Liu,et al.  Follow-up for covered stent treatment of carotid blow-out syndrome in patients with head and neck cancer. , 2016, The British journal of radiology.

[20]  N. Saito,et al.  Treatment of a cervical carotid pseudoaneurysm that occurred years after laryngectomy and irradiation of a neck tumor. , 2011, Neurologia medico-chirurgica.