Endovascular management of carotid artery stenosis secondary to sclerosing mediastinitis

• Published in: Journal of vascular surgery Vol. 56; no. 2; pp. 492 - 495
• Main Authors: Smolock, Christopher J., MD, Blackmon, Shanda, MD, Garami, Zsolt, MD, Hassoun, Heitham T., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2012; Elsevier
• Subjects: Angiography; Angioplasty, Balloon; Biological and medical sciences; Carotid Artery, Internal - diagnostic imaging; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - etiology; Carotid Stenosis - therapy; Embolic Protection Devices; Endovascular Procedures - methods; Female; Fibrosis; Humans; Mediastinitis - complications; Mediastinitis - pathology; Medical sciences; Middle Aged; Neurology; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex; Vascular diseases and vascular malformations of the nervous system; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Carotid stenosis; Nervous system diseases; Mediastinum disease; Cardiovascular disease; Endovascular route; Cerebral disorder; Arterial disease; Vascular disease; Clinical management; Surgery; Central nervous system disease; Cerebrovascular disease; Fibrosing mediastinitis
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2012.01.058

Sclerosing mediastinitis is a rare, progressive condition characterized by extensive fibrotic reaction. We report the first known case of symptomatic, extrinsic compression of the carotid artery by fibrotic extension of sclerosing mediastinitis. A 54-year-old woman began experiencing neurologic symptoms from extension of a known mediastinal mass resulting in 70% to 79% stenosis of the right internal carotid artery. The stenosis was treated with endovascular stenting. Completion angiogram revealed a good result with <10% residual stenosis. At 18-month follow-up, the patient was symptom free without evidence of re-stenosis. Endovascular therapy provides a novel and durable solution in the midterm to this very rare problem.