Traumatic pseudoaneurysms of external carotid artery branch: Case series and treatment considerations / 中华创伤杂志(英文版)

PURPOSE@#To explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.@*METHODS@#Eleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.@*RESULTS@#Complete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5-2.0 years without recurrence of nosebleed and scalp lump.@*CONCLUSION@#For patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.

Endovascular treatment of iatrogenic pseudoaneurysm and delayed carotid-cavernous fistula following trans-sphenoidal surgery / Tratamiento endovascular de pseudoaneurisma y fístula carótida-cavernosa iatrogénica después de la cirugía trans-esfenoidal

Lesiones accidentales de la arteria carótida son complicaciones poco frecuentes de diversos procedimientos diagnósticos y terapéuticos. Representan una condición grave y potencialmente mortal si el tratamiento no se realiza adecuadamente. Un paciente de sexo femenino, 45 años de edad, que ingresó en el servicio de Otorrinolaringología con queja de la disminución de la agudeza auditiva y acúfenos en el oído izquierdo. La resonancia magnética encefálica mostro una formación expansiva / infiltrativa a comprometer desde la nasofaringe izquierda hasta la base del cráneo, con la participación de la arteria carótida interna (ACI) en el mismo lado en su segmento petroso. Durante el procedimiento de biopsia, se produjo una laceración en la carótida derecha intracavernosa con sangrado abundante. Se realizó un taponamiento local y el paciente fue remitido a la angiografía cerebral que mostró un seudoaneurisma en la arteria carótida interna derecha en su segmento cavernoso. Después de una prueba de oclusión, la ACI derecha fue ocluida por 2 globos. Tres semanas después, el estado del paciente mostró empeoramiento progresivo de la agudeza visual, proptosis ocular, hiperemia conjuntival y la restricción del movimiento ocular en el ojo derecho. Una nueva angiografía fue realizada y mostró la persistencia de la oclusión de la ACI en su origen y un seudoaneurisma asociado con fístula carótido-cavernosa derecha, que se opacificado después de la inyección de contraste en la ACI izquierda, a través de la arteria comunicante anterior. El paciente fue sometido a un nuevo tratamiento endovascular con resolución de la lesión. Laceración de ACI durante la cirugía transesfenoidal es una complicación rara y potencialmente fatal. La prevención es el mejor tratamiento para cualquier lesión accidental. La utilización de técnicas endovasculares ha permitido para el tratamiento satisfactorio de esta condición.

Accidental carotid artery lesions are uncommon complications from diverse diagnostic and therapeutic procedures. It represents a grave and potentially lethal condition if treatment is not adequately performed. A female patient, 45 years old, who was admitted to the Otolaryngology service complaining of diminished auditory acuity and tinnitus in the left ear. The encephalic magnetic resonance imaging (MRI) showed an expansive/infiltrative formation compromising the left nasopharynx to the skull base, involving the ipsilateral internal carotid artery (ICA) in its petrous segment. During the biopsy procedure, there was a right intracavernous ICA laceration with copious bleeding. A local tamponade was performed and the patient was referred to cerebral angiography (CAG), which showed a right ICA pseudoaneurysm in its intracavernous segment. After a balloon occlusion test, the right ICA was occluded by 2 balloons. Three weeks after, the patient’s condition showed progressive worsening of visual acuity, occular proptosis, conjuctival hyperemia and occular movement restriction in the right eye. A new CAG was performed and showed persistence in the right ICA occlusion in its origin and an intracavernous pseudoaneurysm associated with ipsilateral carotidcavernous fistula, which became opacified after contrast injection in left ICA, through the anterior communicating artery. The patient was submitted to a new endovascular treatment with lesion resolution. ICA laceration during transsphenoidal surgery is a rare and potentially fatal complication. The prevention is the best treatment for any accidental lesion. Utilization of endovascular techniques has allowed for satisfactory treatment of this condition.

Terapia de recanalização endovascular de oclusão da artéria carótida em paciente com acidente vascular cerebral agudo / Percutaneous recanalization of carotid artery occlusion in patient with and acute stroke

Relatamos o caso de uma paciente de 69 anos, que, após a realização de arteriografia carotídea apresentou trombose sintomática da bifurcação carotídea. A paciente foi submetida imediatamente a reperfusão endovascular mecânica, com implante bem-sucedido de stent carotídeo, obtendo reversão completa do déficit neurológivo.

A 69 year-old woman developed symptomatic internal carotid artery thrombosis after carotid angiography. She was immediately submitted to mechanical endovascular reperfusion with successful carotid stent implantation and complete neurological recovery.

Ruptura carotídea durante angioplastia: tratamento endovascular e seguimento por 5 anos / Carotid artery rupture during angioplasty: endovascular treatment and 5-year follow-up

A angioplastia carotídea emergiu como uma alternativa terapêutica à doença aterosclerótica. Existem inúmeras possíveis complicações inerentes, porém a ruptura é muito rara, e a abordagem terapêutica varia desde a conservadora à operação aberta. Relatamos um caso de ruptura carotídea durante angioplastia, onde o tratamento conservador por tamponamento temporário não resolveu. Optamos pela colocação de um stent revestido, controlando a hemorragia ativa. A paciente recuperou-se integralmente sem nenhuma nova intercorrência, permanecendo assintomática durante todo o seguimento clínico e ecográfico de 61 meses. Concluímos que, apesar de representar uma complicação rara, o risco é real. O tratamento endovascular desse tipo de laceração é seguro e efetivo, com excelente resultado em médio prazo.

Emergency Endovascular Treatment of Internal Carotid Artery Injury During a Transsphenoidal Approach for a Pituitary Tumor: Case Report

Carotid artery injury is a very rare, but life threatening complication that can occur during a transsphenoidal approach. We experienced one case of carotid artery injury during a transsphenoidal pituitary tumor surgery. The patient was immediately treated by a balloon occlusion and complete packing of the cavernous carotid artery using Guglielmi detachable coils (GDCs) and the rest of the tumor was removed after the carotid occlusion. The patient recovered without showing any neurological deficits.

Zumbido por fístula carótido-cavernosa de origem traumática / Post-traumatic caroticocavernous fistula as a cause of tinnitus

Fístula carótido-cavemosa é uma conexäo arteriovenosa entre a artéria carótida interna e o seio cavernoso. É uma entidade rara, principalmente se a queixa única for zumbido. Pode ser classificada de acorcdo com três critérios: traumática ou espontânea, de alto ou baixo fluxo, e diretas ou durais. A sintomatologia é geralmente insidiosa e o diagnóstico por radio-imagem geralmente é feito de um a oito meses após o ocorrido, com média de cinco meses. É relatado um caso de zumbido provocado por uma fístula carótido-cavernosa