Massive Hemorrhage from Internal Carotid Artery Pseudoaneurysm Successfully Treated by Transcatheter Arterial Embolization with Assessment of Regional Cerebral Oxygenation

  • Hideaki Kakizawa
  • Naoyuki Toyota
  • Masashi Hieda
  • Nobuhiko Hirai
  • Toshihiro Tachikake
  • Jun Horiguchi
  • Katsuhide Ito
Case Report

Abstract

A 54-year-old male presented with intermittent massive hemorrhage from recurrent oropharyngeal cancer. The angiogram showed the encasements at the main trunk of the left internal carotid artery (ICA) and external carotid artery (ECA). Transcatheter arterial embolization (TAE) of the ECA with gelatin sponge particles and microcoils was performed. However, hemorrhage recurred several hours after the initial TAE. The second angiogram showed a large pseudoaneurysm of the ICA developing at the encasement on the initial angiogram. As a simple neurologic test, regional cerebral oxygenation (rSO2) was assessed with and without manual compression of the common carotid artery (CCA). With compression of the left CCA, the rSO2 did not change. We therefore performed isolation of the pseudoaneurysm. We embolized proximally and distally to the ICA pseudoaneurysm with microcoils and the pseudoaneurysm disappeared. No major complications occurred and no massive hemorrhage recurred until death from the cancer. TAE was an effective treatment for massive hemorrhage caused by tumor invasion to ICA. Assessment of rSO2 was a simple and useful neurologic test predicting the cerebral blood flow to prevent complications of TAE.

Keywords

Transcatheter arterial embolization (TAE) Internal carotid artery (ICA) Pseudoaneurysm Hemorrhage Regional cerebral oxygenation (rSO2

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Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Hideaki Kakizawa
    • 1
  • Naoyuki Toyota
    • 1
  • Masashi Hieda
    • 1
  • Nobuhiko Hirai
    • 1
  • Toshihiro Tachikake
    • 1
  • Jun Horiguchi
    • 1
  • Katsuhide Ito
    • 1
  1. 1.Department of Radiology, Division of Medical Intelligence and InformaticsPrograms for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima UniversityMinami-kuJapan

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