Hirninfarkt nach Coil-Embolisation der A. carotis interna zur Behandlung einer Luftsackmykose^[*]

Zusammenfassung:

Gegenstand und Ziel: Der Fallbericht beschreibt eine ungewöhnliche Komplikation nach Verschluss der A. carotis interna bei einem Pferd mit Luftsackmykose. Material und Methoden: Eine fünfjährige Haflingerstute wurde aufgrund von Epistaxis vorgestellt. Der Patient wurde klinisch, endoskopisch und labordiagnostisch untersucht. Ergebnisse: Die Diagnose lautete Luftsackmykose mit Blutungsanämie. Die Coil- Embolisation der A. carotis interna gelang intraoperativ nur unvollständig. Etwa 14 Stunden nach dem Eingriff kam es zu neurologischen Ausfällen und schließlich zum Tod des Patienten. Bei der Sektion ergab sich ein Hirnödem mit fokalen Nekrosen und Kompression des Stammhirns. Die Veränderungen wurden von Thromben in den Aufzweigungen der A. carotis interna verursacht, die einen ischämischen Hirninfarkt auslösten. Schlussfolgerung: Nach Coil-Embolisation der A. carotis interna können auch beim Pferd durch Thromben bedingte Komplikationen auftreten. Klinische Relevanz: Bei der Coil-Platzierung in Arterien zur Behandlung einer Luftsackmykose sollte der Eingriff erst beendet werden, wenn ein Blutfluss in Richtung Gehirn nicht mehr nachweisbar ist.

Summary:

Objective: This case report describes an unusual complication after transarterial coil embolisation of the internal carotid in a horse with guttural pouch mycosis. Material and methods: A five-year-old Haflinger mare was presented due to epistaxis. Results: Clinical, endoscopic and hematological findings substantiated the diagnosis of guttural pouch mycosis and blood loss anemia. Transarterial coil embolisation of the internal carotid artery was performed. Neurological signs developed 14 hours after surgery, which aggravated to unconsciousness and death. A post mortem examination revealed edema of the brain with compression of the brain stem. This was the result of thrombi in the branches of the internal carotid artery, initiated by the coils. Conclusion: Thrombotic complications may occur in the horse after treatment of guttural pouch mycosis by transarterial coil embolisation. Clinical relevance: Treatment of guttural pouch mycosis by placing coils should not be completed until assuring that bloodflow towards the brain is nonexistent in that artery.

Schlüsselwörter:

Pferd - Luftsack - Mykose - Epistaxis - Katheter - Coil- Embolisation - Ballon

Key words:

Horse - guttural pouch - mycosis - epistaxis - catheter - coil embolisation - balloon

^* Herrn Prof. (em.) Dr. Olof Dietz zum 80. Geburtstag gewidmet.

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