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Sequential Treatment of Delayed Endovascular Coil Extrusion From a Carotid Artery Pseudoaneurysm After Tonsillectomy ONLINE FIRST

Aria Jafari, MD1; Brian Nuyen, BS2; Suraj Kedarisetty, BS2; Christine A. Fordham, MD1; Javan Nation, MD1,2,3
[+] Author Affiliations
1Division of Otolaryngology–Head & Neck Surgery, Department of Surgery, University of California San Diego, San Diego
2School of Medicine, University of California, San Diego, La Jolla
3Division of Otolaryngology, Department of Surgery, Rady Children’s Hospital, San Diego, California
JAMA Otolaryngol Head Neck Surg. Published online August 25, 2016. doi:10.1001/jamaoto.2016.2246
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This case report describes mucosal extrusion of an endovascular coil following extracranial internal carotid artery pseudoaneurysm treatment in a child with dysphagia and pharyngeal foreign body sensation.

Tonsillectomy is one of the most common surgeries performed in the United States.1 A rare vascular complication of tonsillectomy is extracranial internal carotid artery (ICA) pseudoaneurysm, which occurs when a tear in the arterial wall leads to a hematoma and subsequent development of a periarterial fibrous capsule. Expeditious treatment is required to avoid life-threatening complications.

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Figure 1.
Radiographic Findings of Left Extracranial Internal Carotid Pseudoaneurysm and Coil Extrusion

A, 3 Dimensional (3D) reconstruction of angiogram demonstrating the pseudoaneurysm (PA), white arrowhead points to the left internal carotid artery (ICA). B, Coronal contrast-enhanced computed tomographic angiogram demonstrating the location of coil and stent, white arrowheads point to the common carotid artery (CCA), external carotid artery (ECA), and ICA. Blue arrowheads show coil and asterisk denotes location of stent. C, Lateral soft-tissue x-ray of the neck reveals coil extruded into the oropharynx (OP) at initial presentation. Pink arrowhead indicates extruded coil. D, Lateral soft-tissue x-ray of the neck reveals remnant coil in the parapharyngeal space after fourth removal procedure.

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Figure 2.
Endoscopic View of Extruded Coil Within Oropharynx and After Removal

A, Endoscopic view of oropharynx with extruded coil from the left parapharyngeal and peritonsillar areas. The suction is placed in the superior aspect of the left tonsillar fossa. SP indicates soft palate; U, uvula; LTF, left tonsillar fossa; OP, oropharynx. B, Image of extruded endovascular coil after removal.

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