Carotid blowout syndromeに対しcovered stentで治療するも再出血した1例

A Rebleeding Case of Carotid Blowout Syndrome after Endovascular Treatment with Covered Stent

Ⅰ．はじめに

　Carotid blowout syndrome（CBS）は，頭頚部癌患者の経過中に頚動脈が破裂し大出血を起こす致死的合併症であり，しばしば血管内治療によるsalvageが試みられる．脳虚血耐性の不十分なCBS患者に対し，covered stentを使用し救命し得たものの，34日後に再出血を来した1例を提示し，CBS診療の現状と問題点について報告する．

　We present a case of a patient who survived carotid blowout syndrome（CBS）due to covered stent placement, but bled again 34 days later. A 67-year-old man with laryngeal cancer experienced cardiac arrest due to carotid blowout a day after he underwent the balloon occlusion test and abnormal feeder embolization of the tumor. After quick resuscitation, he was treated with endovascular therapy using a covered stent, since he had insufficient cerebral ischemic tolerance. We succeeded in stent placement and the bleeding stopped without any procedural complications. The patient survived after the procedure. However, bleeding recurred when a nasal endoscope was inserted 34 days later. The rupture point was immediately distal of the stent. We performed carotid artery occlusion with coils and n-butyl-cyanoacrylate. The patient survived, but his condition gradually weakened and died 97 days after stenting. Emergency hemostasis for carotid blowout using a covered stent is the only available treatment for patients who do not have sufficient cerebral ischemic tolerance. However, this procedure has a higher rate of re-bleeding than carotid artery occlusion. Moreover, it is an off-label treatment in Japan. Therefore, possible treatments for CBS including use of covered stent or treatments for non-ruptured CBS should be analyzed in the future.