2026 Poster Presentations
P317: RARE AND UNUSUAL COMPLICATIONS FOLLOWING EMBOLIZATION FOR CAROTID BODY TUMORS
Alex Graboyes; Nikolina Dioufa; Yonghong Huan; Bryan Pukenas; Elizabeth Genovese; Chris Rassekh; Univ of Penn
Background: Carotid Body Tumors (CBTs) are cervical paragangliomas arising at the bifurcation of the carotid artery. Resection sometimes necessitates vascular reconstruction. Digital Subtraction Angiography (DSA) with embolization and in some cases balloon test occlusion (BTO) is useful for these tumors and is relatively low risk but does have potential morbidity and remains somewhat controversial in the literature
Methods: Review of 3 cases occurring with rare findings and unusual complications following embolization for CBTs.
Cases:
1) 43 YO male who presented with a neck mass. Patient had negative genetic testing, and biochemical evaluation was normal. Patient had CT and MRI of the neck, which showed a 3.9 cm mass centered in the left carotid bifurcation. Decision was made to pursue surgical resection with preoperative embolization. Embolization was uneventful. The R wrist was selected for the procedure. No balloon test occlusion (BOT) was performed and the L ascending pharyngeal artery was successfully embolized. Surgery was successful, with gross total resection with negative pathological margins. Post-operative recovery was complicated by first bite syndrome, which resolved fully, and R radial artery occlusion, which required no further treatment.
2) 45 YO female with a neck mass. Patient had negative genetic testing, and biochemical evaluation was normal. Patient had CT, MRI, and DOTATE of the neck, which showed a 2.7 cm mass in the L carotid area. Decision was made to pursue surgical resection with embolization. Successful left embolization using Onyx (Medtronic, MN, USA) of the ascending pharyngeal artery via the R wrist. BTO was then performed. After approximately 10 minutes of carotid occlusion, the patient developed subtle asymmetry in the left half of the face indicating failure of BTO. The next morning, before resection, it was noted the patient had developed a left-sided Horner's syndrome. Decision was made to postpone the CBT resection. Ophthalmology was consulted and recommended no acute intervention. Horner’s resolved. She had a gross total resection 4 months later, with no post-operative complications. Embolic material was seen in vasa vasorum.
3) 44 YO female with SDHB mutation who had a carotid body tumor with apparent retropharyngeal extension. At surgery, the retropharyngeal mass was thought to be a lymph node. Excision revealed a separate focus of paraganglioma. This did not receive embolic material but the carotid body tumor did. It was in very close proximity to the sympathetic trunk but the patient had no Horner's or first bite syndrome postoperatively.
Conclusions: Our paraganglioma team frequently utilizes angiography and embolization for carotid body tumors and this has been helpful in many cases and with rare complications. These cases demonstrate uncommon findings and rare complications of embolization. Balloon test occlusion is similarly controversial. Further research is necessary to clarify the patient selection for angiography for both embolization and test occlusion, however patients should be advised on all potential complications following embolization for CBTs. We propose a management algorithm for patient selection for angiography in CBT. Patients who are selected for radial artery access should be informed of possible loss of the radial artery.