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Lee BC, Lin YH, Lee CW, Liu HM, Huang A. Prediction of Borderzone Infarction by CTA in Patients Undergoing Carotid Embolization for Carotid Blowout. AJNR Am J Neuroradiol 2018; 39:1280-1285. [PMID: 29773563 DOI: 10.3174/ajnr.a5672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Permanent common carotid artery and/or ICA occlusion is an effective treatment for carotid blowout syndrome. Besides postoperative thromboembolic infarction, permanent common carotid artery and/or ICA occlusion may cause borderzone infarction when the collateral flow to the deprived brain territory is inadequate. In this study, we aimed to test the predictive value of CTA for post-permanent common carotid artery and/or ICA occlusion borderzone infarction in patients with carotid blowout syndrome. MATERIALS AND METHODS In this retrospective study, we included 31 patients undergoing unilateral permanent common carotid artery and/or ICA occlusion for carotid blowout syndrome between May 2009 and December 2016. The vascular diameter of the circle of Willis was evaluated using preprocedural CTA, and the risk of borderzone infarction was graded as very high risk, high risk, intermediate risk, low risk, and very low risk. RESULTS The performance of readers' consensus on CTA for predicting borderzone infarction was excellent, with an area under receiver operating characteristic curve of 0.938 (95% confidence interval, 0.85-1.00). We defined very high risk, high risk, and intermediate risk as positive for borderzone infarction, the sensitivity, specificity, positive predictive value, and negative predictive value of CTA for borderzone infarction were 100% (7/7), 62.5% (15/24), 43.8% (7/16), and 100% (15/15), respectively. The interobserver reliability was excellent (κ = 0.807). No significant difference in the receiver operating characteristic curves was found between the 2 readers (P = .114). CONCLUSIONS CTA can be used to predict borderzone infarction after permanent common carotid artery and/or ICA occlusion by measuring the collateral vessels of the circle of Willis.
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Affiliation(s)
- B-C Lee
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Y-H Lin
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C-W Lee
- From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - H-M Liu
- Department of Radiology (H.-M.L.), Fu-Jen Catholic University Hospital, New Taipei, Taiwan
| | - A Huang
- Research Center for Adaptive Data Analysis (A.H.), National Central University, Jhongli, Taiwan
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Horky J, Chaloupka J, Putman C, Roth T, Sasaki C. Large Haemangiopericytoma of the Posterior Cervical Space. Interv Neuroradiol 2016; 3:155-60. [DOI: 10.1177/159101999700300207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/1997] [Accepted: 04/18/1997] [Indexed: 11/16/2022] Open
Abstract
We report a case of a 39-year old woman who upon developing a rapidly enlarging posterior cervical space tumour, underwent incisional biopsy prior to diagnostic imaging that resulted in nearly catastrophic haemorrhage. Subsequently, MR imaging showed evidence of marked hypervascularity, prompting diagnostic angiography and endovascular microembolization prior to surgical resection. The tumour turned out to be a large haemangiopericytoma arising from the paravertebral musculature. The case is instructive by highlighting the need for considering rare locations of hypervascular tumours in the head and neck region before attempting biopsy, which can be predicted by cross-sectional imaging studies, and the benefits of pre-operative devascularization with modern superselective microembolisation techniques.
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Affiliation(s)
- J.K. Horky
- Interventional Neuroradiology Service, Department of Diagnostic Radiology, Section of Neurosurgery, Department of Surgery, Section of Otolaryngology, Department of Surgery, Yale University School of Medicine; New Haven
| | - J.C. Chaloupka
- Interventional Neuroradiology Service, Department of Diagnostic Radiology, Section of Neurosurgery, Department of Surgery, Section of Otolaryngology, Department of Surgery, Yale University School of Medicine; New Haven
| | - C.M. Putman
- Interventional Neuroradiology Service, Department of Diagnostic Radiology, Section of Neurosurgery, Department of Surgery, Section of Otolaryngology, Department of Surgery, Yale University School of Medicine; New Haven
| | - T.C. Roth
- Interventional Neuroradiology Service, Department of Diagnostic Radiology, Section of Neurosurgery, Department of Surgery, Section of Otolaryngology, Department of Surgery, Yale University School of Medicine; New Haven
| | - C.T. Sasaki
- Interventional Neuroradiology Service, Department of Diagnostic Radiology, Section of Neurosurgery, Department of Surgery, Section of Otolaryngology, Department of Surgery, Yale University School of Medicine; New Haven
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Lee CW, Yang CY, Chen YF, Huang A, Wang YH, Liu HM. CT angiography findings in carotid blowout syndrome and its role as a predictor of 1-year survival. AJNR Am J Neuroradiol 2013; 35:562-7. [PMID: 23969344 DOI: 10.3174/ajnr.a3716] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Carotid blowout is a serious late complication of prior treatment of advanced head and neck cancer. We evaluate the efficacy of CTA in the diagnosis of impending carotid blowout syndrome in patients with head and neck cancer, and its capability to predict clinical outcome. MATERIALS AND METHODS The clinical data of 29 patients with impending carotid blowout who underwent CTA were collected and analyzed. Imaging signs included tissue necrosis, exposed artery, viable perivascular tumor, pseudoaneurysm, and contrast extravasation. DSA was obtained in 20 patients. One-year outcomes were compared based on management. RESULTS The most common CTA finding was necrosis (94%), followed by exposed artery (73%), viable tumor (67%), pseudoaneurysm (58%), and contrast extravasation (30%). Exposed artery, pseudoaneurysm, and contrast extravasation were the 3 CTA findings related to outcomes. All of the pseudoaneurysm and contrast extravasation cases were associated with an exposed artery. An exposed artery was the most important prognostic predictor and could not be diagnosed on DSA. Patients without the 3 findings on CTA (group 1) had the best survival rate at 1-year follow-up, followed by patients with the 3 findings treated immediately by permanent artery occlusion (group 2). Patients with the 3 findings who had no immediate treatment (group 3) had the worst outcomes (P < .001 in group 1 vs group 3 and group 2 vs group 3; P = .056 group 1 vs group 2). CONCLUSIONS CTA, with its ability to diagnose an exposed artery compared with DSA, may offer important management and prognostic information in patients with impending carotid blowout.
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Affiliation(s)
- C-W Lee
- From the Department of Medical Imaging and Radiology (C.-W.L., C.-Y.Y., Y.-F.C., Y.-H.W., H.-M.L.), Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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Abstract
INTRODUCTION The incidence of tumors at the craniovertebral junction in the pediatric population is low. Because of the variable pathology and the rarity of these tumors, ideal therapies are only now being defined. MATERIALS AND METHODS Thirty-eight children with tumors affecting the craniocervical junction were encountered between 1991 and 2006. These comprised neoplasms of osseous origin and neural extramedullary tumors. RESULTS AND DISCUSSION Chordomas of the clivus and foramen magnum were seen in eight, fibrous dysplasia in four, aneurysmal bone cysts in four, eosinophilic granuloma affecting the atlas and axis vertebra in four, Ewing's sarcoma involving the atlas in two, osteoblastoma in two, neurenteric cysts in four, meningioma in five, schwannoma in two, and plexiform neurofibromas in three. The location of these tumors was predominantly ventral, and a very small number had a lateral or dorsal location. The ventral tumors included chordoma, meningioma, fibrous dysplasia, aneurysmal bone cyst, and osteoblastoma. Plexiform neurofibroma affecting the craniocervical junction was ventral to the clivus and upper cervical spine causing severe kyphosis of the craniocervical region. Pain in the head and neck occurred in 70%. Paresthesias and dysesthesias in the hands were seen in 40% and spastic weakness of extremities in 22%. Cranial nerve palsies were seen in 33%. Twenty-eight percent of children showed dysphagia or dysarthria. The cranial nerves affected were the vagus followed by hypoglossal and glossopharyngeal nerves. This led to dysphagia, slurred speech, repeated aspiration pneumonia, and weight loss. The most common findings for chordomas at the craniocervical junction were isolated hypoglossal nerve palsy. All individuals underwent magnetic resonance imaging, computed tomography, and 3D computed tomography and angiography. Vertebral angiography was used to understand the dynamics of collateral circulation and tumor vascularity. Tumor embolization was performed in chordoma and aneurysmal bone cysts. Our experience and results are presented here.
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Kizilkilic O. Vertebral artery origin stenting with buddy wire technique in tortuous subclavian artery. Eur J Radiol 2006; 61:120-3. [PMID: 16996712 DOI: 10.1016/j.ejrad.2006.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 08/18/2006] [Accepted: 08/21/2006] [Indexed: 11/24/2022]
Abstract
Catheterization of vessels with severe tortuosity and atherosclerotic changes may represent a technical challenge and is associated with a higher incidence of vascular complications [Putman CM, Chaloupka JC. Use of large-caliber coronary guiding catheters for neurointerventional applications. AJNR Am J Neuroradiol 1996;17:697-704]. Placement of guiding catheter to the tortuous subclavian artery in vertebral artery origin stenting procedure is such a condition with difficulties. In the presence of severe tortuosity of aortic arch and proximal subclavian artery placement of guiding catheter may be difficult and yield poor backup support. We describe a technique that uses a buddy wire to make the guiding catheter stable in its proper position and make possible to perform stenting the vertebral artery origin stenosis.
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Affiliation(s)
- Osman Kizilkilic
- Baskent University Department of Radiology, Adana Teaching and Medical Research Center, 01170 Yuregir-Adana, Turkey.
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Kai Y, Hamada JI, Morioka M, Yano S, Mizuno T, Kuratsu JI. Double microcatheter technique for endovascular coiling of wide-neck aneurysms using a new guiding device for the transcarotid approach: technical note. Neuroradiology 2005; 47:73-7. [PMID: 15647950 DOI: 10.1007/s00234-004-1277-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Accepted: 09/01/2004] [Indexed: 11/30/2022]
Abstract
In the endovascular treatment of cerebrovascular diseases, positioning the guiding catheter is of great importance. In cases where vessel tortuosity prohibits positioning the guiding catheter in the carotid artery via the femoral approach, we use a direct carotid approach via common carotid artery puncture. For direct puncture of the common carotid artery we devised a 6-Fr sheath with double insertion points. This new device facilitates the use of double microcatheters and provides safe and effective vascular access.
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Affiliation(s)
- Yutaka Kai
- Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
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Chaloupka JC, Mangla S, Huddle DC, Roth TC, Mitra S, Ross DA, Sasaki CT. Evolving experience with direct puncture therapeutic embolization for adjunctive and palliative management of head and neck hypervascular neoplasms. Laryngoscope 1999; 109:1864-72. [PMID: 10569424 DOI: 10.1097/00005537-199911000-00028] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The use of percutaneous, direct puncture therapeutic embolization (DPTE) of hypervascular head and neck neoplasms is a relatively new modality that may be used to supplement or supplant conventional endovascular transarterial embolization. Although the preliminary clinical experience reported by a single group has been favorable, extensive case series experience is lacking. This prompted us to review our recent clinical experience with these techniques to determine safety, efficacy, and emerging role in the overall neurointerventional therapeutic armamentarium. STUDY DESIGN A retrospective analysis of the previous 34 consecutive cases of hypervascular tumors undergoing DPTE referred to our service for therapeutic devascularization was performed. METHODS Complete case record review was undertaken. Twenty-six of 34 cases involved DPTE of head and neck neoplasms. Conventional diagnostic angiography was performed for therapeutic planning and to assist in precise localization. When performed, standard microcatheter transarterial embolization techniques were used either before or after attempted DPTE. Cyanoacrylate embolic mixtures (n-butyl cyanoacrylate [NBCA], lipiodol, powdered tungsten) were used in 21 of 24 cases, and absolute ethanol in 3 of 24. Direct puncture angiography of the targeted tumor neovasculature was always performed before DPTE. RESULTS Twenty-four of 26 cases had technically successful DPTE. Combined transarterial embolization with DPTE was used in 16 of 24 cases, although for the last 12 cases, 9 were treated predominantly or exclusively by DPTE. There were no major or minor clinical complications, and there was one asymptomatic technical complication. Total or near-total devascularization was achieved in all cases. All preoperative cases had excellent hemostasis within the resected tumor bed. CONCLUSIONS Our results lend further support to the safety and efficacy of DPTE in the management of hypervascular neoplasms of the head and neck. With our increasing experience, this technique is evolving into a primary therapeutic modality for optimal tumor devascularization.
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Affiliation(s)
- J C Chaloupka
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242-1077, USA
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Cheramie HS, Pleasant RS, Robertson JL, Moll HD, Carrig CB, Freeman DE, Jensen ME. Evaluation of a technique to occlude the internal carotid artery of horses. Vet Surg 1999; 28:83-90. [PMID: 10100761 DOI: 10.1053/jvet.1999.0083] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate an occlusion technique for the internal carotid artery of horses using an intravascular, detachable, self-sealing, latex balloon distally and ligatures proximally. STUDY DESIGN Experimental study. ANIMALS Six healthy adult horses. METHODS In each horse, the left internal carotid artery was occluded by placement of an intravascular, detachable, self-sealing, latex balloon distally and two ligatures proximally. Radiographs were taken on days 2, 5, 10, and 30 after surgery to evaluate balloon inflation and position. Endoscopic examination of the left guttural pouch was performed 10 days after surgery to evaluate the integrity of the internal carotid artery and surrounding tissues. At 30 days, the left and right, common, internal, and external carotid arteries were examined grossly and then processed for histologic evaluation. RESULTS Immediate and long-term occlusion of the left internal carotid artery was achieved in all horses. The surgical procedure was technically straightforward and no intraoperative or postoperative complications were encountered. The balloons remained inflated and in their original position throughout the study. Maturing to mature, organized thrombi were present in the left internal carotid artery in all horses at 30 days. The cerebral arterial circle and common carotid artery were patent at their junctions with the internal carotid artery in all horses. CONCLUSIONS Use of an intravascular, detachable, self-sealing, latex balloon distally and ligatures proximally is an effective technique for occluding the internal carotid artery of horses. CLINICAL RELEVANCE This technique may be useful for prevention of fatal hemorrhage in horses with lesions of the internal carotid artery.
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Affiliation(s)
- H S Cheramie
- Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College Veterinary Medicine, Virginia Tech, Blacksburg, USA
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Chaloupka JC. Evolving Experience with Direct Puncture Therapeutic Embolization for Adjunctive and Palliative Management of Hypervascular Neoplasms. J Vasc Interv Radiol 1999. [DOI: 10.1016/s1051-0443(99)71061-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gutiérrez Díaz R, Sánchez Aniceto G, Romance A, Lobato R, Cabrera A, Alday R. Resección craneofacial anterior. Neurocirugia (Astur) 1999. [DOI: 10.1016/s1130-1473(99)70788-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dare AO, Chaloupka JC, Putman CM, Fayad PB, Awad IA. Failure of the hypotensive provocative test during temporary balloon test occlusion of the internal carotid artery to predict delayed hemodynamic ischemia after therapeutic carotid occlusion. SURGICAL NEUROLOGY 1998; 50:147-55; discussion 155-6. [PMID: 9701120 DOI: 10.1016/s0090-3019(97)00444-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extensive experience and critical evaluation of the efficacy of a pharmacologic hypotensive challenge during conventional balloon test occlusion (BTO) of the internal carotid artery (ICA) is lacking. This prompted us to review our institution's most recent experience with this adjunctive provocative test before planned therapeutic balloon occlusion of the ICA. METHODS Twenty consecutive cases of endovascular therapeutic balloon occlusion of the ICA were retrospectively reviewed. Conventional BTO under normotension and with hypotensive challenge were performed within a standardized protocol. RESULTS Sixteen patients underwent provocative testing, of which 13 had BTO with hypotensive challenge. All patients in this group tolerated these maneuvers without acute neurologic deficit. Two (15%) of these patients developed delayed permanent neurologic deficits, which seemed to be attributable to hemodynamic ischemia. One of seven patients not undergoing hypotensive challenge also developed transient neurologic deficits after carotid occlusion. CONCLUSIONS Despite the conceptually attractive and early positive experience of the hypotensive challenge in attempting to increase sensitivity and specificity of risk for developing delayed hemodynamic ischemia, we have found two significant false-negative results. This experience is reviewed in the context of risks of permanent balloon occlusion of the carotid artery after balloon test occlusion.
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Affiliation(s)
- A O Dare
- Interventional Neuroradiology Service, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8042, USA
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Ronkainen A, Hernesniemi J, Puranen M, Niemitukia L, Vanninen R, Ryynänen M, Kuivaniemi H, Tromp G. Familial intracranial aneurysms. Lancet 1997; 349:380-4. [PMID: 9033463 DOI: 10.1016/s0140-6736(97)80009-8] [Citation(s) in RCA: 183] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We set out to determine the prevalence of incidental intracranial aneurysms in first-degree relatives aged 30 years or more of people with intracranial aneurysms, and to see if polycystic kidney disease contributes to the aggregation of familial intracranial aneurysms. METHODS 91 families with two or more affected members had previously been identified from a 14 year series of 1150 intracranial aneurysm patients treated at the University Hospital of Kuopio, Finland. Magnetic resonance angiography was used as a preliminary screening method, followed by conventional four-vessel angiography to verify suspected aneurysms. Participants were also screened for polycystic kidneys by ultrasonography. FINDINGS Incidental aneurysms were detected in 40 individuals: 38 of 438 individuals from 85 families without polycystic kidney disease or other diagnosed heritable disorders, and two of 22 individuals from six families known to have polycystic kidney disease. The crude and age-adjusted prevalence of incidental intracranial aneurysms among screened first-degree relatives was 8.7 (SE 1.3)% (95% CI 6.2-11.7) and 9.1 (1.4)% (6.2-11.7), respectively, for the familial group and the crude prevalence for the polycystic kidney group was 9.1 (6.1)% (1.1-29.2). INTERPRETATION Our results demonstrate a high prevalence of incidental intracranial aneurysms among first-degree relatives aged 30 years or older of patients with the condition and indicate that the risk of having an aneurysm is about four times higher for a close relative than for someone from the general population. Also, polycystic kidney disease families are a small fraction of the familial intracranial aneurysm families.
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Affiliation(s)
- A Ronkainen
- Department of Neurosurgery, University Hospital of Kuopio, Finland
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Citardi MJ, Chaloupka JC, Son YH, Ariyan S, Sasaki CT. Management of carotid artery rupture by monitored endovascular therapeutic occlusion (1988-1994). Laryngoscope 1995; 105:1086-92. [PMID: 7564841 DOI: 10.1288/00005537-199510000-00015] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The reported mortality (40%) and neurologic morbidity (25%) rates for carotid rupture remain unacceptably high. This study was conducted to assess the impact of endovascular detachable balloon occlusion and the changing characteristics of carotid rupture in head and neck surgery. Between January 1, 1988, and June 30, 1994, 18 carotid ruptures were identified in 15 patients. Etiologic factors included radical surgery, radiation therapy, wound complications, and recurrent or persistent carcinoma. In 15 of 18 instances of carotid rupture, patients survived without major neurologic sequelae. After the introduction of endovascular techniques in 1991, the 12 patients whose hemorrhage was definitively managed through permanent balloon occlusion survived without significant neurologic sequelae. Endovascular occlusion techniques in the monitored patient may significantly improve the outcome after carotid rupture.
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Affiliation(s)
- M J Citardi
- Department of Surgery, Yale University School of Medicine, New Haven, Conn 06520-8041, USA
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