應用覆膜支架來解決治療頸動脈爆裂症候群時所發生內漏的狀況－病例報告

Endoleak Occurs During the Treatment of Carotid Blowout Syndrome and Can Be Treated Using Viabahn Stent Graft - Case Report

陳尚著(Shang-Zhu Chen)；蘇仁沛(Jen-Pei Su)；陳智偉(Chih-Wei Chen)；張凱傑(Kai-Jie Chang)；曾紫綺(Zih-Chi Tseng)；鄭伃婷(Yu-Ting Cheng)

頸動脈爆裂症候群 ； 覆膜支架 ； 總頸動脈 ； 內頸動脈 ； 內漏 ； Carotid Blowout syndrome ； Viabahn stent graft ； common carotid artery ； internal carotid artery ； endoleak

中華放射線技術學雜誌

48卷1期（2024 / 03 / 01）

30 - 34

繁體中文;英文

頸動脈爆裂症候群（carotid blowout syndrome，CBS）是頭頸部癌症的一種併發症，如果不及時診斷和治療，有可能會迅速致命。此病例為患者左側總頸動脈（left common carotid artery，LCCA）分歧處發生急性破裂出血，由放射科醫師立即在左側內頸動脈（left internal carotid artery，LICA）至LCCA之間執行覆膜支架（Viabahn Stent Graft）植入術進行止血；然而在Stent Graft處不斷發生內漏（endoleak）。因此在內漏的部位再度放置兩個Viabahn Stent Grafts且彼此頭尾相接並保留重複覆蓋區，藉以能夠更完整地覆蓋LICA至LCCA；最後在LCCA注射對比劑後，顯示三支Viabahn Stent Grafts開口端及相對位置皆十分良好且左前循環分支動脈血流良好，有效成功地處理在介入性血管攝影診療流程中，所發生罕見多次內漏併發症。

Carotid blowout syndrome (CBS) emerges as a perilous complication in head and neck cancer cases, potentially resulting in fatality without prompt diagnosis and intervention. This case study outlines an instance where a patient experienced a rupture at the bifurcation of the left common carotid artery (LCCA). Radiologists undertook vascular repair by deploying a Viabahn stent graft to halt the bleeding. However, an immediate endoleak occurred after placing the stent graft between the left internal carotid artery (LICA) and LCCA. To address this, two additional Viabahn stent grafts were strategically positioned at the site of the endoleaks, connected sequentially to comprehensively cover the area from LICA to LCCA. Contrast medium injection into LCCA revealed an optimal opening state and alignment of the three covered stents, with no observable arterial defects. The successful application of stent extensions effectively mitigated the rare complications of multiple endoleaks from the initial stent placement, resolving the carotid blowout.