Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer: A case report

doi:10.12998/wjcc.v10.i25.9121

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Sep 6, 2022; 10(25): 9121-9126
Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.9121

Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer: A case report

Jung-Soo Park, Hyoung Gyu Jang

Jung-Soo Park, Hyoung Gyu Jang, Department of Neurosurgery, Jeonbuk National University Medical School and Hospital, Jeonju 54907, South Korea

Author contributions: Park JS wrote the manuscript; Park JS and Jang HG collected the data and participated in patient care; Jang HG reviewed and edited the manuscript.

Supported by Fund of Biomedical Research Institute, Jeonbuk National University Hospital.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: All the authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Hyoung Gyu Jang, MD, Attending Doctor, Department of Neurosurgery, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54709, South Korea. 23175@jbuh.co.kr

Received: April 13, 2022
Peer-review started: April 13, 2022
First decision: May 31, 2022
Revised: June 13, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: September 6, 2022
Processing time: 134 Days and 1.8 Hours

Abstract

BACKGROUND

Radiation therapy (RT) for nasopharyngeal cancer can cause several complications. In rare cases, an internal carotid artery pseudoaneurysm can occur, which can be fatal. We report the experience of a nasopharyngeal cancer patient who underwent radiation therapy and subsequently developed a fatal pseudoaneurysm of the petrous internal carotid artery.

CASE SUMMARY

A 39-year-old man was diagnosed with nasopharyngeal cancer 2 years ago (American Joint Committee on Cancer Stage T3N2M0) and received concurrent chemoradiation therapy. He subsequently relapsed and received chemotherapy. One week after the 4th cycle of chemotherapy, he was admitted to the emergency room of our hospital because of massive epistaxis accompanied by a headache. A pseudoaneurysm of the petrous internal carotid artery was confirmed by digital subtraction angiography (DSA). Stent-assisted endovascular coil embolization was performed and complete occlusion was achieved. No pseudoaneurysm was observed on DSA after coil embolization; however, intermittent epistaxis was maintained even after coil embolization. After seven days, a diagnostic laryngoscopy was performed. Massive bleeding occurred after aspiration of the blood clot during the laryngoscopy and the patient died of hypovolemic shock. In this case, epistaxis may have been a sign of pseudoaneurysm; therefore, treatment such as embolization should be performed promptly, and careful management should be undertaken after treatment.

CONCLUSION

This case highlights a rare, serious complication of RT in nasopharyngeal cancer and how it should be recognized and treated.

Keywords: Pseudoaneurysm; Nasopharyngeal cancer; Radiation therapy; Epistaxis; Carotid artery pseudoaneurysm; Case report

Core Tip: We report a patient who developed pseudoaneurysm in a nasopharyngeal cancer patient. By reporting our mistakes, we hope that our readers will not make the same mistakes as us.