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British Journal of Radiology (2006) 79, 226-231
© 2006 British Institute of Radiology
doi: 10.1259/bjr/66917189
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Life-threatening common carotid artery blowout: rescue treatment with a newly designed self-expanding covered nitinol stent

H S Kim, MD1, D H Lee, MD, PhD1, H J Kim, MD4, S J Kim, MD, PhD1, W Kim, MD2, S Y Kim, MD, PhD3 and D C Suh, MD, PhD1

1 Department of Radiology,, 2 Emergency Medicine and, 3 Otorhinolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, 388-1 Poongnap Dong, Songpa-Gu, Seoul, 138-736, 4 Department of Radiology, DaeJeon Catholic Hospital, Republic of Korea


Figure 1
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  		Figure 1. Photographs of the covered stent(Taewoong Medical, Seoul, Korea) composed of a self-expanding nitinol wire covered with PTFE. (a) The 10 mm x 50 mm stent used secondarily in cases 1 and 2 consists of proximal and distal bare segments of 5 mm and a middle covered area of 40 mm. (b) Note the structural relationship of the stent wire and PTFE graft. Outer polyurethane layer connects the stent wire and PTFE graft. Stent wire thickness is 0.007'' in size.

 

Figure 2
Figure 2
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  		Figure 2. A 62-year-old male with unresectable oesophageal carcinoma presented with massive bleeding at the neck wound site associated with deep neck infection after radiation therapy.(a) Conventional angiogram shows a large pseudoaneurysm in the mid-portion of the left common carotid artery (CCA). (b) 11 days after the first stent placement. Conventional angiography shows extension of the previous pseudoaneurysm at the lower margin of the stent. ) (c) After placement of an additional stent, angiography shows no recurrent haemorrhage.

 

Figure 3
Figure 3
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  		Figure 3. A 57-year-old man with inoperable nasopharyngeal carcinoma treated with radical neck dissection and radiation therapy presented with massive oral bleeding.(a) The right common carotid arteriogram shows a pseudoaneurysm formation and contrast leakage into pharynx and oral cavity near the carotid bulb. (b) Immediate angiography after stent placement and coil embolisation revealed a small contrast leakage out of the distal portion of the covered stent due to luminal diameter discrepancy between the proximal internal carotid artery (ICA) and the covered stent caused by the transitional lumen size of the carotid bulb. ) (c) Final angiography shows no further leakage of the contrast agent after deployment of another self-expanding stent crossing the distal end of the covered stent. The patient became stable immediately after procedure.

 




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