Abstract 348: Optimizing carotid body tumor embolization: The role of flow arrest using EMBOGUARD
™
Balloon Guide Catheter
Authors: Rana R. , Sehgal N. , Baskaran A. , Metman O. Verhagen , Kothari S. , Desai H. , Smith M. , Chahine A. , Siegler J. , Patel S. , Morsi R. Z. , Thind S. , Hurley M. , Kass‐Hout T. 
Published: January 2025

Introduction

Preoperative embolization is a known and acceptable adjunct to surgical resection of carotid body tumors (CBTs). Current literature depicts devascularization primarily through the transarterial route with superselective catheterization and embolization of feeding vessels by use of liquid or particle embolic agents. Less commonly used practices include percutaneous direct tumor puncture, coil embolization, a combined percutaneous and transarterial approach, and covered stent placement. Few studies have reported on embolization techniques that utilize balloon occlusion for assistance. We present our initial experience in pre‐treatment of CBTs using a combined approach of established embolization techniques and balloon occlusion of the external carotid artery (ECA) via the EMBOGUARD
™
Balloon Guide Catheter.

Methods

We performed a retrospective review of medical records from March 2023 to February 2024. The study included patients over 18 years old diagnosed with a carotid body tumor who had pre‐operative embolization using the the EMBOGUARD
™
Balloon Guide Catheter. The primary outcome measure was the degree of angiographic devascularization achieved, categorized as either near‐total or total occlusion of the tumor's feeding arteries. Safety outcomes included procedural complications, such as non‐target embolization into previously uninvolved territories and cranial nerve deficits affecting the glossopharyngeal, vagus, hypoglossal, or sympathetic chain.

Results

Three patients were included in this retrospective study, all of whom were female (100.0%, n=3/3). The median (standard deviation [SD]) age was 29.0 (±17.4) years. Two patients underwent transarterial embolization using a combination of Onyx, n‐butylcyanoacrylate, and coils. One patient had percutaneous direct tumor puncture embolization. In all cases, the external carotid artery (ECA) trunk was completely occluded using a balloon catheter during embolization. Near‐total angiographic devascularization of the tumor was achieved in all three patients (100.0%). There were no immediate complications or neurological deficits related to the embolization procedures. However, one patient experienced vocal cord paresis that persisted for six months following surgical resection of the tumor.

Conclusions

Using the EMBOGUARD
™
Balloon Guide Catheter to temporarily occlude the ECA during embolization of CBTs offers several advantages: prevents retrograde reflux of embolic particles into the internal carotid artery and intracranial circulation, reducing the risk of stroke; blocks anterograde flow in the ECA minimizing the chances of embolic material migrating into the ECA branches and causing complications like cranial nerve palsies; and stagnates blood flow to allow for more controlled and precise delivery of embolic agents into the tumor vasculature, which can improve the degree of angiographic devascularization achieved.