High Altitude Carotid Body Tumors Growth During active Surveillance.

BACKGROUND: The gold standard for patients with carotid body tumors (CBT) is surgical resection; nevertheless, some patients are unfit for surgery or, for other reasons, could not be operated on. Active surveillance has been known to be a reasonable strategy for these cases. This study aimed to evaluate tumor growth in unoperated patients with CBTs. METHODS: A retrospective review of all unoperated patients with CBT from a single academic hospital diagnosed between 2014 and 2021 was performed. Results of nonparametric testing were presented using the median and ranges for Mann-Whitney-U or Kruskal-Wallis. Significance was defined as a 2-tailed P < .05. RESULTS: The cohort included a total of 31 patients, with a median age of 60 years (range: 37-80 years), of which 27 (87.1%) were females. The patients live at a median altitude of 2800 meters (range: 2756-2980 meters) above sea level. Twenty (64.5%) patients had Shamblin I tumors, eight (25.8%) patients had Shamblin II tumors, and three (9.7%) patients had Shamblin III tumors. Median CBT volume at diagnosis was 14.1 cm3 (range: .9 - 213.3 cm3). Median volume at diagnosis of symptomatic tumors was substantially larger than asymptomatic tumors, 49.2 cm3 vs 7.9 cm3, respectively (P = .03). Median growth of the tumors during a median 15-month follow-up (range: 3-43 months) was 3.3 cm3 (range: 0-199.9 cm3). Overall, 77% (n = 24) of the CBTs grew at least 1 cm3. CONCLUSION: Most patients in the present study had tumor growth by at least 1 cm3, with a median tumor growth of 3.3 cm.3 In the present study tumor growth was shown to be greater than other low altitude CBT active surveillance studies; therefore, surgical resection should be recommended in patients with CBT living at high altitudes.

Stent micromallado para el tratamiento del aneurisma cervical sintomático de la arteria carótida interna / Micromesh stent for treating a of symptomatic cervical internal carotid artery aneurysm

Introducción: el manejo y tratamiento de un aneurisma carotídeo espontáneo mediante técnica endovascularmínimamente invasiva es un procedimiento poco frecuente y que en este caso resultó en la exclusión de la circulación del aneurisma manteniendo la permeabilidad de la arteria carótida interna y sus ramas terminales cerebrales.Caso clínico: presentamos el caso de un hombre de 61 años con antecedente de hipertensión arterial y seis eventoscerebrovasculares previos con microlesiones cerebrales sin focalidad neurológica. La investigación angiográfi careveló un aneurisma de arteria carótida interna izquierda segmento cervical (C1) de cuello ancho, sacular, causanteposiblemente de la sintomatología del paciente.Discusión: se indicó manejo percutáneo endovascular defi nitivo del aneurisma utilizado técnica estándar y colocación de stent micromallado (CGuard™), cubriendo el cuello y logrando la exclusión inmediata del aneurismacarotídeo. El seguimiento al mes del procedimiento confi rmó el cierre, la permeabilidad carotídea y resolución desintomatología.

Introduction: the management and treatment of a spontaneous carotid aneurysm using a minimally invasiveendovascular technique is a rare procedure. This case resulted in the exclusion of the aneurysm from circulation,maintaining the patency of the internal carotid artery and its terminal cerebral branches.Case report: we present the case of a 61-year-old man with a history of arterial hypertension and six previouscerebrovascular events with brain micro-injuries without neurological focus. Angiographic investigation revealedan aneurysm of the left internal carotid artery, cervical segment (C1) of wide neck, saccular, possibly causing thepatient’s symptoms.Discussion: defi nitive percutaneous endovascular management of the aneurysm was indicated using standardtechnique and micro malted stent placement (CGuard™), covering the neck and achieving immediate exclusion ofthe carotid aneurysm. Follow-up one month after the procedure confi rmed closure, carotid patency and resolutionof symptoms.