Transarterial glue embolization and covered stenting of a large carotid body tumor in the same setting: neuroendovascular surgical video.

Affiliation

Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, 60612. Electronic address: [Email]

Abstract

Surgical resection is considered to be the treatment of choice for carotid body tumors. However, surgery can be complicated by intraoperative bleeding, injury to the internal carotid artery, and cerebral ischemia. Consequently, preoperative endovascular strategies may be used, including transarterial or percutaneous embolization or covered carotid stenting. These neuroendovascular techniques have been described infrequently in the literature. Here, we showcase transarterial glue embolization followed by covered carotid stenting of a large carotid body tumor in the same setting. A 53-year-old male presented with a 6 cm pulsatile and enlarging neck mass as well as swallowing difficulty. Craniofacial computed tomography scan and digital subtraction angiography were consistent with a carotid body tumor. It was decided to perform preoperative embolization. Using roadmap guidance, a Prowler microcatheter (Codman Neurovascular, Inc., Raynham, MA) was navigated into a tumor feeder vessel and a dilute 12% concentration (mix of 1 mL glue and 7 mL ethiodized oil) of the liquid embolic agent N-BCA (N-butyl cyanoacrylate; Codman Neurovascular, Inc., Raynham, MA) was injected and seen to cast the tumor. During embolization, D5 water was injected through the guide catheter to enhance glue penetration into the tumor bed. Then, 2 covered stents (iCAST, Atrium Medical Corporation, Hudson, NH) were deployed within the cervical internal carotid artery extending from levels C1-C6, spanning the carotid bifurcation, and excluding the external carotid artery. The patient underwent surgical resection 8 weeks later. The patient recovered from the procedures without any complications. Informed consent for the procedure and publication was obtained.