A novel approach to the management of carotid blowout syndrome: the use of thrombin in a case of failed covered stenting.
Publication/Presentation Date
12-1-2016
Abstract
Acute hemorrhage relating to an expanding pseudoaneurysm of the carotid artery is referred to as carotid blowout syndrome (CBS). CBS is associated with a high morbidity and mortality. We describe the case of a patient who presented with dysphagia and a pulsatile mass in the neck. Imaging revealed a pseudoaneurysm originating from the bifurcation of the distal right common carotid artery. On neuroangiography the patient lacked sufficient collaterals to allow for vessel sacrifice. A decision was made to use covered stents to prevent flow into the pseudoaneurysm while maintaining vessel patency. Despite placement of multiple covered stents there was residual slow filling of the pseudoaneurysm. We augmented this therapy with direct percutaneous thrombin injection into the pseudoaneurysm. This resulted in complete thrombosis of the pseudoaneurysm. For recalcitrant lesions in which the usual methods of stopping blood flow to the pseudoaneurysmal sac fail, an adjuvant approach with thrombin should be considered.
Volume
8
Issue
12
First Page
49
Last Page
49
ISSN
1759-8486
Published In/Presented At
Sablani, N., Jain, G., Hasan, M. M., Sivakumar, K., Feuerwerker, S., Arcot, K., & Farkas, J. (2016). A novel approach to the management of carotid blowout syndrome: the use of thrombin in a case of failed covered stenting. Journal of neurointerventional surgery, 8(12), e49. https://doi.org/10.1136/neurintsurg-2015-012121.rep
Disciplines
Medicine and Health Sciences
PubMedID
26932800
Department(s)
Department of Medicine, Department of Medicine Fellows and Residents, Fellows and Residents
Document Type
Article