E4583. Common and Uncommon Transcatheter Extracranial Head and Neck Embolization: A Resident Primer
Authors
Mina Al-Ani;
Kings County Hospital Center; SUNY Downstate Medical Center
Latika Baranga;
Kings County Hospital Center; SUNY Downstate Medical Center
Aala Saadallah;
Kings County Hospital Center; SUNY Downstate Medical Center
Adil Afridi;
Kings County Hospital Center; SUNY Downstate Medical Center
Neda Sedora-Roman;
Kings County Hospital Center
Ike Thacker;
Baylor University Medical Center
Mougnyan Cox;
Baylor University Medical Center
Background
Transcatheter embolization is commonly requested for cessation of head and neck hemorrhage as well as an adjunct procedure to limit the blood loss of surgical resection of vascular tumors. In addition to safe and meticulous catheter technique, detailed knowledge of the vascular supply of the head and neck area is a prerequisite for successful embolization.
Educational Goals / Teaching Points
In this presentation, we aim to highlight the pertinent neurovascular anatomy as well as pearls and pitfalls for common and uncommon extracranial head and neck embolization requests.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Understanding extracranial vascular anatomy, including the main branches, normal variants, and common sites of anastomosis, is crucial for external carotid artery (ECA) endovascular interventions. Common indications for transcatheter extracranial embolization include intractable epistaxis, chronic subdural hemorrhage, pre-resection size reduction of meningioma, management of carotid body tumors, and juvenile nasopharyngeal angiofibroma.
Conclusion
Familiarity with the anatomy of the extracranial circulation is important to avoid potential side effects including those arising from inadvertent embolization of intracranial supply through anastomosis to the cerebral circulation. In this context, we discuss the role of preoperative imaging, potential pitfalls, the choice of embolic agent, and postprocedural care in addressing both common and uncommon indications of transcatheter extracranial head and neck embolization.
