HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Fig. 1. (A) Left carotid space abscess abutting the carotid artery. (B) Successful embolization of left common carotid artery with Amplatzer plugs. (C) Focused digital pressure over the site of rupture. Notice the cervical spine hardware that precluded spine extension in this case and hence limited surgical access. (D) Preserved contralateral flow after left vertebral artery injection via a patent posterior communicating artery.

Postintervention DSA images via injection of the left vertebral artery showed adequate filling of left middle cerebral artery distribution via a patent posterior com- municating artery (Fig. 1D). Management of Threatened CBS Case 2. A 52-year-old male presented with recur- rent supraglottic squamous cell cancer treated initially with definitive chemoradiation. Salvage laryngectomy and reconstruction with radial forearm free flap was per- formed. One month after the procedure, he developed a large right pharyngocutaneous fistula with exposed carotid artery (Fig. 2A). He was admitted with concerns for threatened CBS and a covered stent was placed in the right CCA (Fig. 2B). Clopidogrel (antiplatelet ther- apy) was started. He then underwent successful balloon occlusion testing (BOT). Nutritional and hypothyroid status was optimized and endovascular sacrifice of CCA was then performed (Fig. 2C). Following embolization, he had transient neurological symptoms that completely resolved conservatively. The neck wound was then debrided and eventually closed. He has been doing well with no evidence of recurrence or rebleed 18 months after the embolization procedure.

Fig. 2. (A) Exposed right carotid artery in the neck wound. (B) Pre- served flow after covered stent placement in the right carotid artery. (C) Endovascular sacrifice of right carotid artery.

Laryngoscope 127: February 2017

Manzoor et al.: Endovascular Techniques for Management of CBS

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