Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer: A case report

BACKGROUND: Radiation therapy (RT) for nasopharyngeal cancer can cause several complications. In rare cases, an internal carotid artery pseudoaneurysm can occur, which can be fatal. We report the experience of a nasopharyngeal cancer patient who underwent radiation therapy and subsequently developed a fatal pseudoaneurysm of the petrous internal carotid artery. CASE SUMMARY: A 39-year-old man was diagnosed with nasopharyngeal cancer 2 years ago (American Joint Committee on Cancer Stage T3N2M0) and received concurrent chemoradiation therapy. He subsequently relapsed and received chemotherapy. One week after the 4th cycle of chemotherapy, he was admitted to the emergency room of our hospital because of massive epistaxis accompanied by a headache. A pseudoaneurysm of the petrous internal carotid artery was confirmed by digital subtraction angiography (DSA). Stent-assisted endovascular coil embolization was performed and complete occlusion was achieved. No pseudoaneurysm was observed on DSA after coil embolization; however, intermittent epistaxis was maintained even after coil embolization. After seven days, a diagnostic laryngoscopy was performed. Massive bleeding occurred after aspiration of the blood clot during the laryngoscopy and the patient died of hypovolemic shock. In this case, epistaxis may have been a sign of pseudoaneurysm; therefore, treatment such as embolization should be performed promptly, and careful management should be undertaken after treatment. CONCLUSION: This case highlights a rare, serious complication of RT in nasopharyngeal cancer and how it should be recognized and treated.