Neurointervention.  2021 Nov;16(3):298-302. 10.5469/neuroint.2021.00248.

Cascade of Complications Following Carotid Body Tumor Excision

• Garg PK
• Tiwari S
• Ghosh TS
• Patel S
• Sharma A
• Khera PS

• KMID: 2522046
• DOI: http://doi.org/10.5469/neuroint.2021.00248

Abstract

Carotid body tumor excision can lead to various complications including vascular injury and pseudoaneurysm formation. Here we describe a case of carotid body tumor excision followed by series of complications including pseudoaneurysm formation, failure of primary surgical repair, carotid stump syndrome following parent artery occlusion, and persistent hypotension.

Keyword

Carotid body tumor; Carotid artery injury; Carotid artery; Stroke

Figure

• 

  Fig. 1. (A) Computed tomography (CT) angiography baseline, volume rendering technique image showing left carotid body tumor (asterisk). (B) Day-8, post-operative CT showing a pseudoaneurysm (white arrow). (C) Day-25, left common carotid artery (CCA) angiogram confirmed the pseudoaneurysm arising from the medial wall with active contrast extravasation (white arrow). Balloon test occlusion (not shown) showed adequate cross flow across anterior communicating artery with the venous delay of less than 2 seconds. (D) Left CCA run showing occluded CCA by coils (black arrow). (E) Day-25, Post 6 hours of left CCA parent artery occlusion, magnetic resonance imaging (MRI) diffusion weighted image (DWI) at the level of corona radiata showing multiple foci of diffusion restriction (white arrows), suggestive of left-sided ACA-MCA territory watershed infarcts. (F) Day-26, MRI DWI at the level of pons showing multifocal patchy areas of diffusion restriction (dashed arrows), suggestive of acute infarcts involving posterior circulation. (G) Schematic diagram showing migration of emboli from left CCA stump to posterior circulation (left CCA stump → left subclavian artery → left vertebral artery → posterior circulation).

Reference

1. Texakalidis P, Charisis N, Giannopoulos S, Xenos D, Rangel-Castilla L, Tassiopoulos AK, et al. Role of preoperative embolization in carotid body tumor surgery: a systematic review and meta-analysis. World Neurosurg. 2019; 129:503–513.e2.

2. Sylvester PT, Moran CJ, Derdeyn CP, Cross DT, Dacey RG, Zipfel GJ, et al. Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature. J Neurosurg. 2016; 125:1256–1276.

3. Irvine CD. The significance of one occluded internal carotid artery. Eur J Vasc Endovasc Surg. 1998; 16:91–93.

4. Cassidy L, Grace PA, Bouchier-Hayes DJ. The carotid stump syndrome. Eur J Vasc Surg. 1992; 6:368–370.

5. Quill DS, Colgan MP, Sumner DS. Carotid stump syndrome: a colour-coded Doppler flow study. Eur J Vasc Surg. 1989; 3:79–83.

6. Georgiadis D, Grosset DG, Lees KR. Transhemispheric passage of microemboli in patients with unilateral internal carotid artery occlusion. Stroke. 1993; 24:1664–1666.

7. Fields WS, Lemak NA. Joint study of extracranial arterial occlusion. X. Internal carotid artery occlusion. JAMA. 1976; 235:2734–2738.

8. Zhang XU, Shao S, Zheng X, Gao X, Zhang Y. Carotid stump syndrome: a case report. Exp Ther Med. 2015; 10:1161–1164.

9. Dakhoul LT, Tawk R. Carotid stump syndrome: case report and endovascular treatment. J Investig Med High Impact Case Rep. 2014; 2:2324709614548796.

10. Lakshminarayan R, Scott PM, Robinson GJ, Ettles DF. Carotid stump syndrome: pathophysiology and endovascular treatment options. Cardiovasc Intervent Radiol. 2011. 34 Suppl 2:S48–S52.

11. Omoto S, Hasegawa Y, Sakai K, Matsuno H, Arai A, Terasawa Y, et al. Common carotid artery stump syndrome due to mobile thrombus detected by carotid duplex ultrasonography. J Stroke Cerebrovasc Dis. 2016; 25:e205–e207.

12. Naylor AR, Bell PR, Bolia A. Endovascular treatment of carotid stump syndrome. J Vasc Surg. 2003; 38:593–595.

13. Paivanas N, Bisognano J. Unilateral carotid body resection in resistant hypertension: an exciting first step toward a new therapy? JACC Basic Transl Sci. 2016; 1:325–327.

14. Narkiewicz K, Ratcliffe LE, Hart EC, Briant LJ, Chrostowska M, Wolf J, et al. Unilateral carotid body resection in resistant hypertension: a safety and feasibility trial. JACC Basic Transl Sci. 2016; 1:313–324.

15. Fudim M, Groom KL, Laffer CL, Netterville JL, Robertson D, Elijovich F. Effects of carotid body tumor resection on the blood pressure of essential hypertensive patients. J Am Soc Hypertens. 2015; 9:435–442.