A case of percutaneous acute revascularization for internal carotid artery involved by oropharyngeal cancer

Internal carotid artery stenosis commonly occurs after radiotherapy for head and neck cancer; however, there are only a few reports on cases of stenosis or occlusion of the internal carotid artery due to tumor enlargement or invasion and acute endovascular treatment in such cases. We report a case of hemodynamic cerebral infarction caused by compression and due to invasion of oropharyngeal cancer in which neurological symptoms improved after acute endovascular revascularization. A 61-year-old woman ongoing radiation chemotherapy following excision of a right lateral pharyngeal cancer impaired consciousness and left hemiplegia. Head MRI showed multiple cerebral infarctions in the right anterior cerebral artery region, and MRA revealed occlusion of the right common carotid artery. A tumor exposed in the neck displayed blood oozing. Acute endovascular revascularization was performed approximately 3 hours after the last time the patient was seen well. The right internal carotid artery was occluded at a position invaded by the tumor. Aspiration of the thrombus from the proximal area induced recanalization of the internal carotid artery. Percutaneous transarterial angioplasty was performed for the remaining severe stenosis. Neurological findings markedly improved, and there was no progression ofthe cerebral infarction. Enhanced CT on the 5th day showed tumor invasion into the internal carotid artery; however, on the 15th day, the right internal carotid artery was re-occluded, resulting in transient paralysis of the left upper extremity. At that time, stenting was reconsidered to prevent recurrence, but no additional treatment was performed, and the patient was discharged with a modified Rankin Scale score of 3. Even in cases of carotid stenosis caused by the involvement or compression of the internal carotid artery, treatment must be considered for temporary blood flow restoration, leading to favorable patient outcomes.