Complications of balloon catheterization associated with aberrant cerebral arterial anatomy in a horse with guttural pouch mycosis.

This study describes how a case of throat fungus in a horse was complicated due to abnormal brain artery anatomy, which led to severe health issues and eventual death during the treatment involving the use of a balloon catheter.

Background

• The study revolves around the treatment of a 3-year-old Quarter Horse which developed the condition known as guttural pouch mycosis, a fungal infection that develops in the guttural pouches of horses and can potentially result in serious complications such as fatal nosebleeds.
• To treat the condition, a balloon catheterization procedure was performed on the left internal carotid artery of the horse. This is a minimally invasive procedure where a small tube is inserted into a blood vessel and guided into the area affected by the disease.

Treatment and Complications

• The catheter advanced less than the normally expected distance, however, this was not alarming as it was observed endoscopically to be correctly placed within the artery.
• The horse post-procedure developed persistent abnormal breathing, failed to regain consciousness, developed lung fluid overload (pulmonary edema), and eventually died 5.5 hours post-surgery.

Postmortem Analysis

• A postmortem analysis was conducted to determine the cause of death and it was identified that the horse’s left internal carotid artery had an atypical branching pattern. The catheter was found lodged at the junction of the basilar artery and lower brain artery.
• On microscopic examination, it was found the horse had suffered brain stem nerve cell death and lung fluid overload on a cellular level.

Conclusion

• The study suggests that identifying abnormal arterial branching patterns in horses, potentially using angiography techniques, before performing invasive procedures like balloon catheterization is crucial for avoiding severe or fatal errors.
• Not detecting and blocking off these abnormal branches can lead to fatal complications such as uncontrollable nosebleeds and brain stem lesions, as evidenced by the case of the horse in this study.