Extracranial vertebral artery to middle cerebral artery bypass in therapeutic internal carotid artery occlusion for epipharyngeal carcinoma: A technical case report

Background: Vertebral artery (VA) to middle cerebral artery (MCA) bypass is a rarely selected technique because a complex expanded dissection is required, and often, a better donor artery than VA exists. A good indication for VA-MCA bypass is the treatment of head-and-neck malignancies with the sacrifice of the internal carotid artery (ICA) or for carotid artery rupture. Methods: A 23-year-old man with epipharyngeal carcinoma, treated by ligating the carotid artery with a VAMCA bypass before chemoradiotherapy, was reported. Radiographic findings showed that the bone of the carotid canal was dissolved, and the right ICA was engulfed by the tumor. As epipharyngeal carcinoma is hypersensitive to radiation, in cases where the tumor rapidly disappears, ICA may dangle in the pharynx and rupture may occur. In addition, to irradiate sufficiently, the ICA may become an obstacle. Hence, we decided to perform carotid ligation with a VA-MCA bypass before radiation and chemotherapy for the primary lesion. We selected the V3 portion of the VA as the donor on the ipsilateral side, as it can supply high-flow cerebral blood flow, which is not influenced by carcinoma and less influenced by irradiation for the epipharynx. Results: The VA-MCA bypass was completed without complications followed by endovascular occlusion of the ICA. Induction chemotherapy was initiated for the patient 2 weeks after surgery. The patient achieved a complete response following chemoradiotherapy. Conclusion: ICA ligation with VA-MCA high-flow bypass earlier than chemoradiotherapy is useful for epipharyngeal carcinoma as it prevents carotid artery rupture and allows radical intervention.

Devastating iatrogenic internal carotid artery rupture in endoscopic endonasal surgery rescued by a covered stent

This paper reported a case of devastating iatrogenic ICA rupture in endoscopic endonasal surgery (EES) rescued by a covered stent. We also discussed the therapeutic strategies of iatrogenic ICA rupture in EES, which is of help in the management of this devastating complication.

Lead to elevate the temperature and speed of emergency rescue and nursing care of common carotid artery rupture and massive hemorrhage after operation of typical esophageal cancer

Objective: Objective To explore the first aid and nursing of patients with anastomotic fistula after radical resection of esophagus carcinoma complicated with major carotid hemorrhage.Methods: The clinical data of anastomotic fistula complicated with carotid artery rupture and massive hemorrhage after radical resection of typical esophageal carcinoma were analyzed and summarized.Results:Through the close cooperation of medical care, the rescue was successful.Conclusion:Earlier prevention observation, raising first aid consciousness and actively cooperating with doctors can improve the success rate of rescue.

Sphenoid Wall Dehiscence: A Preventable Cause of Iatrogenic Internal Carotid Artery Rupture

Minimally Invasive approaches to pituitary tumor have become gold standard not just for pituitary surgery but also for pathologies of ventral skull base [1]. It is due to the fantastic view it offers and the ease of doing surgery. The same, however, are not without complications and rupture of Internal Carotid Artery (ICA) is potentially the most catastrophic and thus, most feared [2].