Case report – intranasal migration of an endovascular coil out of the internal carotid artery

A 64-year-old man with previous history of nasopharyngeal carcinoma (cT1N2bM0G3) was treated with definitive chemoradiotherapy including Cisplatin until December 2014.

In September 2015 an arrosion bleeding from the internal carotid artery occurred in the nasopharyngeal zone. Endovascular coiling of the internal carotid artery was performed following a successful cessation of the bleeding without any neurological deficits. In October 2017 the patient presented to our out-patient department in clinically stable condition with a dislocated coil reaching out of his right nostril. A contrast agent CT revealed a complete obliteration of the right internal carotid artery by cranial and caudal coiling material but a dislocation of the median Coil into the nasopharynx. The ablation of the material via transnasal access was performed.

Several biopsies from the right nasopharynx showed distinct necrosis but no indication of tumor recrudescence.

We have described a rare complication of endovascular coil migration within postradiogenic necrotic tissue. We would like to demonstrate our decision process concerning the patients' therapy with regard to otherwise successful tumor therapy. In literature, no systematic evaluation can be found. There are only some individual cases of extrusion of coils into the soft tissue of the neck, the middle ear or the trachea.

Publication History

Publication Date:
18 April 2018 (online)