Dong Joon Kim

Neurointervention

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44 www.neurointervention.orgCommentaryNeurointervention 2020;15:44-45https://doi.org/10.5469/neuroint.2020.00017pISSN  2093-9043eISSN  2233-6273Commentary to: Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endo-vascular Deconstructice Embolization for Carotid Blowout SyndromeDong Joon Kim, MD, PhDDepartment of Radiology, Yonsei University College of Medicine, Seoul, Korea The authors reported their successful bailout experience of transcarotid me-chanical thrombectomy of an intracrani-al embolic occlusion after parent vessel sacrifice due to an impending carotid blowout syndrome.1Endovascular management of carotid blowout syndrome is one of the most urgent experiences for a neurointerven-tionist who must make fast and critical decisions under suboptimal conditions. The patient is usually chronically ill and may be vitally unstable due to the bleeding. There is a lack of information on the vascular anatomy, and usually no premedication has been prescribed. Deconstructive parent vessel occlusion or reconstructive stent-graft placement can be endovascular options for treat-ing carotid blowout syndrome with regards to the anatomy and collateral circulation.2-4 An ischemic complication is a concern related to the endovas-cular treatment and may be related to hemodynamic insufficiency following deconstructive treatment or throm-bo-embolic complications caused by the reconstructive treatment without sufficient pre/post antiplatelet medica-tions.2 Intra-procedural embolic stroke from migration of the embolic materials or thrombus formed during deconstruc-tive treatment can be another potential complication as seen in this report.1Similar to the carotid stump syndrome, a thrombus formed from stasis of blood in the internal carotid artery (ICA) with distal migration by antegrade/collateral flow or migration of thrombus formed in the common carotid artery/external carotid artery (ECA) through ECA-ICA anastomosis can be potential mecha-nisms.1,5 For prevention of this compli-cation, ICA sacrifice from the level prox-imal to the ophthalmic artery to the site of carotid rupture may be considered to prevent potential petrocavernous ECA-ICA collateral flow related to thrombus migration. Some physicians advocate the use of dual lumen balloons for ante-grade flow arrest during embolization.6In this study, endovascular manage-ment of an intracranial occlusion was complicated because the parent vessel was sacrificed. Thrombolytic drugs were not an option due to concerns of hemorrhage. In this regard, direct carotid puncture is a technique that has regained interest as a feasible intracrani-al access option for patients with a poor Correspondence to:  Dong Joon Kim, MD, PhDDepartment of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, KoreaTel: +82-2-2228-7400Fax: +82-2-2227-8337E-mail: djkimmd@yuhs.acReceived: January 16, 2020Accepted: February 12, 2020neurointervention Copyright © 2020 Korean Society of Interventional Neuroradiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.https://doi.org/10.5469/neuroint.2020.00017Kim DJ. Commentary to: Transcervical Thrombectomy after Endovascular Carotid Sacrifice45vascular anatomy.7 Despite the added difficulties of an oc-cluded proximal parent vessel (ICA) and the irradiated neck in this patient, the authors have successfully bailed out of a difficult situation by judiciously executing the carotid access technique under fluoroscopic guidance and achieving time-ly mechanical recanalization of the intracranial occlusion. REFERENCES1. Lu CJ, Lin YH, Lee CW. Transcarotid mechanical thrombectomy for embolic intracranial large vessel occlusion after endovascu-lar deconstructice embolization for carotid blowout syndrome. Neurointervention 2020;15:37-432. Wan WS, Lai V, Lau HY, Wong YC, Poon WL, Tan CB. Endovascular treatment paradigm of carotid blowout syndrome: review of 8-years experience. Eur J Radiol 2013;82:95-993. Pyun HW, Lee DH, Yoo HM, Lee JH, Choi CG, Kim SJ, et al. Place-ment of covered stents for carotid blowout in patients with head and neck cancer: Follow-up results after rescue treat-ments. AJNR Am J Neuroradiol 2007;28:1594-15984. Kim HS, Lee DH, Kim HJ, Kim SJ, Kim W, Kim SY, et al. Life-threat-ening common carotid artery blowout: rescue treatment with a newly designed self-expanding covered nitinol stent. Br J Radiol 2006;79:226-2315. Xu Z, Wang J, Luo B. Interventional recanalization as a treat-ment of carotid stump syndrome caused by right internal carotid artery occlusion: a case report. Medicine (Baltimore) 2019;98:e171526. Gonzalez LF, Albuquerque FC, McDougall CG, Conerly K, His-cock TY, Chumbley K, et al. Neurointerventional techniques : Tricks of the trade. New York: Thieme, 20157. Roche A, Griffin E, Looby S, Brennan P, O’Hare A, Thornton J, et al. Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke. J Neurointerv Surg 2019;11:647-652

Commentary to: Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome

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Commentary to: Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome

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