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首页> 美国卫生研究院文献>BMJ Case Reports >Case Report: A novel approach to the management of carotid blowout syndrome: the use of thrombin in a case of failed covered stenting
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Case Report: A novel approach to the management of carotid blowout syndrome: the use of thrombin in a case of failed covered stenting

机译：病例报告：一种新的颈动脉爆裂综合症治疗方法：在覆膜支架置入失败的情况下使用凝血酶

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Acute hemorrhage relating to an expanding pseudoaneurysm of the carotid artery is referred to as carotid blowout syndrome (CBS). CBS is associated with a high morbidity and mortality. We describe the case of a patient who presented with dysphagia and a pulsatile mass in the neck. Imaging revealed a pseudoaneurysm originating from the bifurcation of the distal right common carotid artery. On neuroangiography the patient lacked sufficient collaterals to allow for vessel sacrifice. A decision was made to use covered stents to prevent flow into the pseudoaneurysm while maintaining vessel patency. Despite placement of multiple covered stents there was residual slow filling of the pseudoaneurysm. We augmented this therapy with direct percutaneous thrombin injection into the pseudoaneurysm. This resulted in complete thrombosis of the pseudoaneurysm. For recalcitrant lesions in which the usual methods of stopping blood flow to the pseudoaneurysmal sac fail, an adjuvant approach with thrombin should be considered.
机译：与颈动脉扩大的假性动脉瘤有关的急性出血称为颈动脉爆裂综合症（CBS）。 CBS与高发病率和高死亡率有关。我们描述了患者吞咽困难和颈部搏动性肿块。影像学检查发现假性动脉瘤起源于右颈总动脉远端分叉。在神经血管造影上，患者缺乏足够的侧支以牺牲血管。决定使用覆膜支架以防止流入假性动脉瘤，同时保持血管通畅。尽管放置了多个覆盖的支架，假性动脉瘤仍残留缓慢充盈。我们通过将经皮凝血酶直接注入假性动脉瘤中来增强这种疗法。这导致假性动脉瘤完全血栓形成。对于顽固性病变，其中通常无法阻止血液流向假性动脉瘤囊的方法，应考虑使用凝血酶辅助治疗。

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