Delayed development of brain abscesses following stent-graft placement in a head and neck cancer patient presenting with carotid blowout syndrome

Cardiovasc Intervent Radiol. 2011 Feb:34 Suppl 2:S31-5. doi: 10.1007/s00270-009-9778-1. Epub 2009 Dec 24.

Abstract

We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. Three months later, the patient suffered a recurrent hemorrhage. CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aneurysm, False / diagnosis
  • Aneurysm, False / surgery*
  • Aneurysm, Ruptured / diagnosis
  • Aneurysm, Ruptured / surgery*
  • Angiography*
  • Balloon Occlusion
  • Blood Vessel Prosthesis Implantation*
  • Brain Abscess / diagnosis
  • Brain Abscess / etiology*
  • Carcinoma, Squamous Cell / complications*
  • Carcinoma, Squamous Cell / pathology
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / surgery*
  • Carotid Artery Thrombosis / diagnosis
  • Carotid Artery Thrombosis / etiology
  • Carotid Artery, Common*
  • Coated Materials, Biocompatible*
  • Emergencies*
  • Humans
  • Image Processing, Computer-Assisted*
  • Imaging, Three-Dimensional*
  • Laryngeal Neoplasms / complications*
  • Laryngeal Neoplasms / pathology
  • Magnetic Resonance Imaging
  • Male
  • Neoplasm Staging
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Recurrence
  • Stents*
  • Syndrome
  • Tomography, X-Ray Computed

Substances

  • Coated Materials, Biocompatible