Korean J Radiol.  2007 Jun;8(3):249-253. 10.3348/kjr.2007.8.3.249.

Stroke from Delayed Embolization of Polymerized Glue Following Percutaneous Direct Injection of a Carotid Body Tumor

• Krishnamoorthy T
• Gupta AK
• Rajan JE
• Thomas B

• KMID: 1779443
• DOI: http://doi.org/10.3348/kjr.2007.8.3.249

Abstract

A 52-year-old male with right carotid body tumor underwent direct percutaneous glue (n-butylcyanoacrylate [NBCA]) embolization. Several hours later, he developed left hemiparesis from embolization of the polymerized glue cast. Migration of glue during percutaneous tumor embolization is presumed to occur only in the liquid state, which may lead to stroke or cranial nerve deficits. To the best of our knowledge, this is the first report of delayed glue embolization from a treated hypervascular tumor of the head and neck.

Keyword

Carotid body tumor; Glue; Stroke; Embolization

MeSH Terms

Carotid Body Tumor/blood supply/*therapy
Cyanoacrylates/administration & dosage/*adverse effects
Embolization, Therapeutic/*methods
Enbucrilate
Foreign-Body Migration/*complications
Humans
Injections, Intralesional
Male
Middle Aged
Stroke/*etiology

Figure

• 

  Fig. 1 A. Right carotid injection in the lateral view shows the hypervascular tumor with posterior displacement of the internal carotid artery. B. Oblique view of right carotid injection with balloon occlusion of the external carotid artery shows the feeder from the internal carotid artery. C. Balloon occlusion of the internal carotid artery with common carotid injection shows the residual vascular supply from the external carotid artery following embolization of the ascending pharyngeal artery. Note the tip of the needle for direct glue injection is well away from the internal carotid artery (arrow). D. Glue cast of the tumor after final embolization. E. Right common carotid injection in the lateral view at the end of the procedure shows near total devascularization of the tumor. A residual small area of tumor blush is seen posteriorly (arrow). Note the patent internal carotid artery flow. The overlying glue cast is mimicking artifactual filling defects in the internal carotid artery. F. Right common carotid injection in the oblique view clearly shows the internal carotid artery lumen is separate from the glue cast (arrow).

• 

  Fig. 2 A. Preprocedure right carotid injection in the lateral view shows the normal intracranial circulation. B. Immediate post procedure right carotid injection in the lateral view shows the preserved flow in all the cortical branches of the middle cerebral artery, including the rolandic and parietal branches. C. The non-enhanced CT scan of the brain at the level of the Circle of Willis shows the dense glue in the right sylvian fissure close to the location of the M2 segment (arrow). D. Right carotid lateral view six months later shows non-visualization of the rolandic and parietal branches of the middle cerebral artery, and this is suggestive of persistent occlusion.

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