Trans-arterial coil embolization of the internal carotid artery in standing horses.
Authors: Benredouane Kossay, Lepage Olivier
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Trans-arterial Coil Embolization for Internal Carotid Artery Occlusion in Standing Horses Guttural pouch mycosis remains a life-threatening condition in horses, with haemorrhage from the internal carotid artery being the primary cause of mortality; this study evaluated whether transarterial coil embolization (TACE) performed in the standing horse under fluoroscopic guidance could safely occlude the ICA and prevent catastrophic bleeding in affected animals. Eight healthy horses and five with confirmed GPM underwent TACE whilst standing, with four of the normal horses euthanased at two weeks for histological examination and the remainder monitored for either six months (normal horses) or 10–12 months (GPM cases). Complete vessel occlusion was achieved in all cases with no procedure-related complications; angiographic confirmation showed appropriate coil positioning and preserved local haemodynamics, whilst histology revealed mature thrombus formation at two weeks post-procedure. Of the three GPM horses that survived the immediate post-operative period, mycotic lesions resolved completely without additional intervention, demonstrating the technique's efficacy. For practitioners managing horses unsuitable for general anaesthesia or presenting with acute guttural pouch disease, TACE offers a genuinely minimally invasive alternative to traditional surgical approaches, though awareness of potential neurologic sequelae following ICA occlusion remains essential for appropriate client communication and post-operative management.
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Practical Takeaways
- •TACE is a safe, minimally invasive alternative to general anesthesia for preventing hemorrhage in horses with guttural pouch mycosis, particularly valuable for horses at high anesthetic risk
- •The procedure can be performed successfully in standing horses under fluoroscopic guidance with complete vessel occlusion and no hemodynamic compromise
- •Expect some residual neurologic deficits post-procedure, but these do not necessarily reflect poor outcomes or require additional intervention
Key Findings
- •Transarterial coil embolization successfully occluded the internal carotid artery in all 8 normal horses with no procedure-related complications
- •Complete vessel occlusion was confirmed angiographically in standing position under fluoroscopic guidance without altering local hemodynamics
- •In 3 surviving horses with guttural pouch mycosis, mycotic lesions completely resolved without additional treatment following TACE
- •Residual neurologic deficits occurred as a common sequela but did not indicate treatment failure