John Chaloupka
Florida International University, Neurosurgery, Faculty Member
Research Interests:
Research Interests:
Purpose: The initial FDA approval trial of the self-expanding Wingspan stent for symptomatic intracranial atherosclerotic disease demonstrated a 4.5% periprocedural complication rate. Subsequently, similar on-label registry data was... more
Purpose: The initial FDA approval trial of the self-expanding Wingspan stent for symptomatic intracranial atherosclerotic disease demonstrated a 4.5% periprocedural complication rate. Subsequently, similar on-label registry data was reported. The WEAVE Trial is a prospective, consecutive enrollment, single-arm, post-market surveillance trial evaluating periprocedural outcomes in patients with the revised FDA indications for use. Methods: Data for the first 102 on-label patients for which completed data is available are included in this report. The primary analysis endpoints included periprocedural stroke, death, or symptomatic bleed within 72 hours of the stenting procedure in patients who were treated on label. A subgroup of the participating sites included anti-platelet therapy resistance testing and correction, if needed, in their treatment of the patient. All patient outcomes were separately adjudicated by a stroke Neurologist by 72 to 96 hours post procedure. Results: In the initial 122 consecutive patients enrolled with completed data, 102 patients were treated on label and are included in the primary analysis, and 20 patients were treated off label and were part of secondary analyses. The mean stenosis in the primary analysis group was 83% with target artery break down as follows: 40.2% MCA, 25.5% ICA, 19.6% Basilar, 14.7% Vertebral or VB junction. Of the 102 patients in the primary analysis, 3 patients (2.9%) reached a primary endpoint of stroke, symptomatic bleed, or death within 72 hours. In the off label group, 4 of the 20 patients (20%) reached a primary endpoint within that period. Conclusions: The early interim analysis of the first 102 patients of WEAVE trial has demonstrated a very low periprocedural morbidity and mortality of 2.9%. This is lower than the high periprocedural event rate in the SAMMPRIS trial, and statistically better than the outcomes in the off label group (Fisher’s Exact test p value 0.014). This early data provides impetus to continue to collect data in this trial, and lends support to the concept that refined patient selection criteria and establishment of best practice techniques and management for these patients can substantially decrease the peri-procedural risk of intracranial stenting.
Research Interests:
As a result of positive energetic balance of organism, there is a cumulation of an excessive energy in the adipose tissue. Adipose tissue repletion represents the main characteristic of obesity. The objective of our work was to perform... more
As a result of positive energetic balance of organism, there is a cumulation of an excessive energy in the adipose tissue. Adipose tissue repletion represents the main characteristic of obesity. The objective of our work was to perform the comparative study for the evaluation of selected noninvasive methods used for the determination of body composition. We analysed the results of 4 methods of the body composition measurement: bioelectrical impedance (BIA), physical anthropometry (ANTHR), Deurenberg's calculation (FORM) and dual energy X-ray absorptiometry (DEN). The most statistically significant correlation was proved between the results of BIA and results of DEN method (r = 0.9145), and results of BIA and FORM method (r = 0.9014).
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Medicine, Humans, Male, Clinical Sciences, Neuroblastoma, and 3 moreAdult, Thoracic Vertebrae, and Vertebra
Research Interests:
Arteriovenous fistulae of the ascending pharyngeal artery (AP) and internal jugular vein (IJ) are rare. Only two spontaneous AP-IJ fistulae have been described previously, both of which presented with pulsatile tinnitus. A unique case of... more
Arteriovenous fistulae of the ascending pharyngeal artery (AP) and internal jugular vein (IJ) are rare. Only two spontaneous AP-IJ fistulae have been described previously, both of which presented with pulsatile tinnitus. A unique case of an AP-IJ fistula developing after radical neck dissection is described in which the clinical presentation was identical to that of a carotid-cavernous fistula.
Research Interests: Fistula, Medicine, Humans, Neuroradiology, Male, and 13 moreFollow-up studies, Differential Diagnosis, Clinical Sciences, Angiography, Middle Aged, Oral Squamous Cell Carcinoma (OSCC), Neurosciences, Internal Carotid Artery, Postoperative Complications, Pharynx, Neck dissection, Tongue neoplasms, and Arteriovenous Fistula
We report a case of pigmented villonodular synovitis involving the temporomandibular joint that presented as a rapidly growing tumor with extension through the skull base into the middle cranial fossa. The case is of interest not only... more
We report a case of pigmented villonodular synovitis involving the temporomandibular joint that presented as a rapidly growing tumor with extension through the skull base into the middle cranial fossa. The case is of interest not only because of the unusual extensive infiltration of this tumor but also because of the role modern diagnostic imaging and endovascular therapeutic techniques played in its diagnosis and management.
Research Interests:
Research Interests:
Research Interests: Neurosurgery, Risk assessment, Medicine, Stents, Humans, and 15 moreFemale, Male, Recurrence, Clinical Sciences, Angioplasty, Aged, Middle Aged, Retrospective Studies, Risk Assessment, Stent, Neurosciences, Restenosis, Postoperative Complications, stenosis, and Cardiovascular medicine and haematology
Research Interests:
To determine the association of cerebral arterial anomalies and progressive cerebral arterial occlusive disease in infants with facial hemangiomas. The cases of eight infants (seven girls and one boy) with the diagnosis of cervicofacial... more
To determine the association of cerebral arterial anomalies and progressive cerebral arterial occlusive disease in infants with facial hemangiomas. The cases of eight infants (seven girls and one boy) with the diagnosis of cervicofacial hemangioma and intracranial arterial anomalies were reviewed retrospectively. Findings from clinical and imaging examinations--including cranial computed tomography, magnetic resonance imaging and angiography, and catheter angiography--were evaluated. Serial imaging findings were studied to document progressive intracranial vascular changes. Five patients had additional associated congenital anomalies. Seven were treated with corticosteroids, interferon alfa-2a, or both. Progressive cerebrovascular occlusive changes were documented in four of the seven patients with serial imaging findings. Four other patients (all treated pharmacologically) had MR imaging documentation of cerebral infarction, and all had consistent, acquired neurologic symptoms. Intracranial arterial anomalies can coexist with cervicofacial hemangioma. Aneurysmal and occlusive changes are potentially progressive and can result in cerebral infarction. A causative association between occlusive cerebrovascular disease and pharmacologic treatment has not been excluded.
Research Interests: Radiology, Magnetic Resonance Imaging, Medicine, Humans, Female, and 14 moreMale, Infant, Angiography, Newborn Infant, Retrospective Studies, X ray Computed Tomography, Intracranial Arteriovenous Malformations, Cerebral Infarction, Magnetic resonance angiography, Cerebral Angiography, hemangioma, Head and neck neoplasms, Nervous system malformations, and Medical and Health Sciences
BackgroundNo randomized trial of intracranial aneurysm coiling has compared long-term efficacy of polymer-modified coils to bare metal coils (BMCs). We report 5-year results comparing Matrix2 coils to BMCs. The primary objective was to... more
BackgroundNo randomized trial of intracranial aneurysm coiling has compared long-term efficacy of polymer-modified coils to bare metal coils (BMCs). We report 5-year results comparing Matrix2 coils to BMCs. The primary objective was to compare the rates of target aneurysm recurrence (TAR) at 12 months. Secondary objectives included angiographic outcomes at TAR or 12 months and TAR at 5 years.MethodsA total of 626 patients were randomized to BMCs or Matrix2 coils. Detailed methods and 1-year results have been published previously.ResultsOf 580 patients eligible for 5-year follow-up, 431 (74.3%) completed follow-up or reached TAR. Matrix2 coils were non-inferior to BMCs (P=0.8) but did not confer any benefit. Core lab reported post-treatment residual aneurysm filling (Raymond III) correlated with TAR (P<0.0001) and with aneurysm hemorrhage after treatment (P<0.008). Repeat aneurysmal hemorrhage after treatment, but before hospital discharge, occurred in three patients treated fo...
Research Interests:
We report a neonate in whom clinical and radiologic studies revealed features of both neurocutaneous melanosis and a Dandy-Walker malformation. We suggest that the association of these two conditions is perhaps not chance.
Research Interests:
Research Interests:
Research Interests: Cognitive Science, Neurology, Medicine, Humans, Male, and 15 moreRisk factors, Aspirin, Registries, Clinical Sciences, Aged, Middle Aged, Risk Factors, Cerebrovascular Disorders, Neurosciences, Predictive value of tests, Cohort Studies, Restenosis, Clinical Trials as Topic, Randomized Controlled Trials as Topic, and Platelet Aggregation Inhibitors
Objective: Since a simple, rapid and accurate stereotactic system allowing CT monitoring would offer the neurosurgeon several advantages, the feasibility and application accuracy of frameless laser-guided freehand point stereotaxis for... more
Objective: Since a simple, rapid and accurate stereotactic system allowing CT monitoring would offer the neurosurgeon several advantages, the feasibility and application accuracy of frameless laser-guided freehand point stereotaxis for neurosurgical interventions was studied. Methods: A Cartesian coordinate grid mounted upon the far wall of a CT scan room defined a plane. The scanner isocenter defined the origin of a three-dimensional coordinate system. Phantom entry point and target point coordinates were determined by the positional CT cursor. These coordinates were entered into a computer which determined the coordinates of the grid intersection point with a line passing through the entry and target points. A tripod-mounted laser assembly comprising two encased lasers oriented retrograde and antegrade along opposite vectors, was positioned near the grid. The retrograde laser was positioned to illuminate the marked grid intersection point while the antegrade laser simultaneously illuminated the entry point; the beams were thereby aligned along the line of trajectory. The tip of a probe was placed on the entry point; the hub was then moved into the path of the antegrade laser, thereby aligning the probe with the line of trajectory. The probe was then inserted to the target at a trigonometrically calculated distance. Results: Ten consecutive phantom tests averaged 17.5 min. Phantom test application accuracy averaged ±2 mm at an average insertion distance of 7.1 cm. Conclusion: Phantom tests indicate that simple, rapid and accurate CT-monitored frameless laser-guided freehand point stereotaxis is feasible. Clinical investigation is warranted.
Research Interests:
Antiplatelet agents are required to prevent thromboembolic complications from recently deployed intracranial stents, yet they carry a risk of bleeding complications that may be serious in patients with recent subarachnoid hemorrhage.... more
Antiplatelet agents are required to prevent thromboembolic complications from recently deployed intracranial stents, yet they carry a risk of bleeding complications that may be serious in patients with recent subarachnoid hemorrhage. Consecutive patients at a single institution who had ruptured intracranial saccular aneurysms treated with stent assisted coiling were retrospectively reviewed. Our primary outcomes were ischemic stroke related to the stent and bleeding complications possibly related to antithrombotic therapy. Secondary outcomes included 3 month follow-up National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores. 44 aneurysms in 42 patients were treated. Seven patients experienced ischemic strokes during their hospitalization. Five ischemic strokes were secondary to vasospasm; one was definitely related to thrombus formation within the stent and one was possibly related to the stent. Two patients had asymptomatic intracranial hemorrhages and one patient had a symptomatic intracranial hemorrhage. Patients with Hunt and Hess grades I-II (n=25) experienced no stent associated ischemic strokes or symptomatic intracranial hemorrhages. The two stent associated ischemic strokes and one symptomatic intracranial hemorrhage occurred in patients with Hunt and Hess grades III-V (n=17) and patients with external ventricular drains (EVDs) (n=17). Only one patient had disability at the 3 month follow-up that was possibly related to the stent (mRS score of 3 and NIHSS score of 2). These data suggest that higher grade hemorrhage patients, especially those with EVDs, are at greater risk for ischemic stroke and/or bleeding complications than lower grade patients. However, the complications had a small impact on mid-term disability outcomes in this cohort.
Research Interests:
We report a neonate in whom clinical and radiologic studies revealed features of both neurocutaneous melanosis and a Dandy-Walker malformation. We suggest that the association of these two conditions is perhaps not chance.
Research Interests:
Research Interests:
Research Interests: Medicine, Humans, Female, Male, Clinical Sciences, and 8 moreAged, Middle Aged, Intrathecal, Adult, Neurosciences, Ions, Contrast Media, and Myelography
... Radiology 208:65-71, 1998 16. Weissleder R, Moore A, Mahmood U, et al: In vivo magneticresonance imaging of transgene expression. Nat Med 6:351-355, 2000 17. Dai G, Levy O, Carrasco N: Cloning and characterizationof the thyroid iodide... more
... Radiology 208:65-71, 1998 16. Weissleder R, Moore A, Mahmood U, et al: In vivo magneticresonance imaging of transgene expression. Nat Med 6:351-355, 2000 17. Dai G, Levy O, Carrasco N: Cloning and characterizationof the thyroid iodide transporter. ...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Purpose Intracranial dissections (ICDs) of the circle of Willis are recognized as important causes of both ischemic and hemorrhagic cerebrovascular disease. Although endovascular surgery (ES) of ICD has been increasingly reported, large... more
Purpose Intracranial dissections (ICDs) of the circle of Willis are recognized as important causes of both ischemic and hemorrhagic cerebrovascular disease. Although endovascular surgery (ES) of ICD has been increasingly reported, large series safety and efficacy data remain limited for establishing evidence basis of practice. Owing to our large scale cumulative experience with intracranial stent-assisted techniques, we reviewed standard angiographic & clinical end-points to assess safety & efficacy of stent-assisted reconstruction (SAR) ES of ICD. Materials and Methods Consecutive intention-to-treat (ITT) cases of ICD were identified by a prospective database; retrospective analysis revealed 164 consecutive cases of ICD treated by SAR techniques (e.g, stent reconstruction only, stent assisted coiling) from 2003 to 2010. Standardized angiographic & clinical endpoints were defined as: 1: (i). peri-operative technical & angiographic outcomes, (ii)death & neurologic morbidity within 24 h and 30 days, and 2: (i) >30 day cumulative neurologic morbidity & mortality, (ii)follow-up angiographic outcome, (iii) retreatment. Results The ITT rate was 100%; patient demographics: 92F:72M, mean age=48.5 years. Anatomic distribution: 79/164 (48%) anterior and 85/164 (52%) posterior circulation. Lesion characteristics: 103/164 (62%) had associated pseudo-aneurysm (ψAn), 78/164 (47.5%) stenosis, 25/164 (15.2%) intimal flap, 4/164 (%) occlusion, 10/164 (%) with thrombi, and 12/162 with fusiform dilatation. Presentation was ischemic in 77/164 (47%), hemorrhagic in 33/164 (20%), headache in 20/164 (12.2%), neck pain in 12/164 (7.3%), miscellaneous in 15/164 (9.1%), and incidental in 7/164 (4.3%). Stent reconstruction only was performed in 114/164 (70%), stent-assisted coiling in 30/164 (18.3%), SAR with balloon angioplasty in 17/164 (10.4%), and thrombolysis followed by SAR in 3/164 (1.8%). Stents utilized: 144 Neuroform (NF), 108 Enterprises (E), 23 combined NF+E, 19 Wingspans (W), and 6 W combined with either NF or E. More than one stent was used in 88/164 (53.7%), and a single stent in 76/164 (46.3%). Follow-up DSA in 95 cases showed healed dissection in 76, unchanged or increased filling of pseudoaneurysm in 6 (all requiring retreatment), decreasing filling of pseudoaneurysm in 3, clots in 2, occluded stent(s) in 2, and in-stent stenosis >50% in 2. In the remaining 70 cases with no DSA, CTA or MRA were available in 54, which showed healed dissection in 48, decreasing in 3 and increasing in 3. Retreatment was performed in 19/164 (11.6%). There were 18/164 (11%) technical complications, although clinically significant attributable periprocedural (<24 h) morbidity occurred in only 3/164 (1.8%). Cumulative 30-day neurologic morbidity was 7/164 (4.3%), and mortality (from rebleed) in only 1/164 (0.6%). Recurrent stroke after 30 days occurred in 4/163 (2.5%). Conclusions ES of ICD using SAR appears quite safe & effective with acceptable rates of treatment failure and need for retreatment. The most commonly encountered associated lesion was ψAn, which is effectively managed by SAR without and occasionally with coiling.
Research Interests:
Research Interests: Radiology, Rheology, Medicine, Ultrasonography, Animals, and 12 moreFlow measurement, Clinical Sciences, Observer Variation, Arteriovenous Malformations, Swine, Reproducibility of Results, Blood Flow Velocity, Vascular Resistance, Carotid Arteries, Cardiac output, Blood volume pulse, and Medical and Health Sciences
Research Interests:
Research Interests:
Research Interests:
Research Interests:
To evaluate pituitary gland size in cases of dural arteriovenous (AV) fistula in the cavernous sinus and to correlate the size with the degree of AV fistula. Magnetic resonance images in 21 patients with angiographically proved dural AV... more
To evaluate pituitary gland size in cases of dural arteriovenous (AV) fistula in the cavernous sinus and to correlate the size with the degree of AV fistula. Magnetic resonance images in 21 patients with angiographically proved dural AV fistula of the cavernous sinus were retrospectively reviewed. In four patients, findings obtained before and after embolization therapy were compared. The 21 patients were divided into group 1 (severe AV fistula) and group 2 (moderate or mild AV fistula). The superior contour of the pituitary gland was convex or flat in group 1 and flat or concave in group 2. The mean height of the pituitary gland was 9.4 mm +/- 1.5 (standard deviation) in group 1 and 6.7 mm +/- 1.2 in group 2 (P = .0002). After embolization therapy, pituitary gland height decreased and signal intensity voids improved in the four patients and no AV fistula was observed in three. In cases of severe dural AV fistula in the cavernous sinus, the pituitary gland is enlarged, which should not be misdiagnosed as pathologic.
Research Interests:
The development of computer modeling technique of cerebral arteriovenous malformations using circuit network analysis, validated with a previously developed animal model is presented. Such a malformation and its vascular connections are... more
The development of computer modeling technique of cerebral arteriovenous malformations using circuit network analysis, validated with a previously developed animal model is presented. Such a malformation and its vascular connections are rendered into a complex system of interconnecting tubes, which is then simulated by an analogous electrical circuit using commercially available computer software. This methodology was tested using a swine model, of which a detailed computer model was constructed from anatomic and angiographic measurements of the cranial vessels. Flow conditions, before and after creation of the in vivo model, were predicted from the computer model and compared with previously reported in vivo measurements. Detailed analysis of flow within the CAVM nidus was also performed. There was a good correlation between the computer and in vivo models regarding changes in flow and pressure drop across the rete. Flow mapping within the nidus showed localized directional flow that was determined by global inputs, consistent with functional compartmentalization. This method of computer modeling appears promising for studying clinically relevant aspects of cerebral arteriovenous malformation pathophysiology. To our knowledge it is the first computer model to demonstrate functional compartmentalization.
Research Interests:
To conduct a validation study of a Doppler guide wire for potential neuroendovascular applications. A 12-MHz, 0.018-inch Doppler guide wire was evaluated in eight swine under various blood flow conditions using two types of in vivo... more
To conduct a validation study of a Doppler guide wire for potential neuroendovascular applications. A 12-MHz, 0.018-inch Doppler guide wire was evaluated in eight swine under various blood flow conditions using two types of in vivo cerebrovascular models (physiologic and arteriovenous shunting). Flow conditions were mechanically and pharmacologically altered. Doppler average peak velocity was compared with volumetric blood flow, and flow profile corrections were calculated and analyzed. Qualitative aspects of the Doppler guide wire spectra were also assessed. Plots of average peak velocity versus volumetric blood flow showed excellent linear relationships (r2 > 0.94), which were maintained at high flow conditions (average peak velocity, 99 to 236 cm/sec; volumetric blood flow, 392 to 889 mL/min). Values of flow profile correction varied from 0.43 to 0.94 and showed no consistent relationship to changes in volumetric blood flow. The excellent correlation between average peak veloc...
Research Interests:
To conduct technical feasibility and performance studies on a new Doppler-tipped, 0.014-inch micro-guide wire for potential neuroendovascular applications. In vivo microcatheterizations of brachiocephalic arteries were performed in two... more
To conduct technical feasibility and performance studies on a new Doppler-tipped, 0.014-inch micro-guide wire for potential neuroendovascular applications. In vivo microcatheterizations of brachiocephalic arteries were performed in two swine using the 0.014-inch Doppler guide wire and a commonly used microcatheter. A standardized, bench-top method of evaluating basic mechanical properties of micro-guide wires was also used to compare the 0.014-inch Doppler guide wire with a commonly used micro-guide wire. The 0.014-inch Doppler guide wire had similar steerability, tractability, torque control, and distal tip flexibility to the commonly used micro-guide wire in the in vivo simulations. Frequent micro-guide wire exchanges were possible without loss of superselective positioning of the microcatheter. Bench-top testing showed the 0.014-inch Doppler guide wire to have comparable distal tip flexibility and stiffness to the commonly used micro-guide wire. The comparable subjective and obje...
Research Interests:
To determine whether microvascular damage occurs from superselective intraarterial injection of amobarbital sodium using the swine endovascular embolization model. Thirty-four swine underwent percutaneous femoral puncture for... more
To determine whether microvascular damage occurs from superselective intraarterial injection of amobarbital sodium using the swine endovascular embolization model. Thirty-four swine underwent percutaneous femoral puncture for superselective catheterization of the proximal artery of the rete. Varying concentrations of amobarbital sodium were prepared (12.5 to 100 mg/mL solution) in either normal saline or sterile water (105 mOsm/L to 1138 mOsm/L) of which one concentration was infused slowly into one ipsilateral rete. Control infusions were also performed. Histopathologic changes were evaluated at 30 minutes and 10 days after infusion, using standard light and electron microscopy techniques. Moderate vasospasm occurred only in three swine at 100 mg/mL amobarbital sodium in normal saline. Light microscopy showed no significant histologic changes in the retia at any of the tested concentrations of amobarbital sodium. Electron microscopy showed ultrastructural alterations in the intima ...
Research Interests: Water, Microcirculation, Testing, Medicine, Capillaries, and 15 moreAnimals, Anesthesia, Clinical Sciences, Sodium, Time Factors, Swine, Saline, Intracranial Arteriovenous Malformations, Sodium Chloride, Neurosciences, Amobarbital, Cerebral Angiography, Femoral Artery, Pharynx, and cerebral arteries
Research Interests:
Research Interests: Cognitive Science, Cardiology, Neurology, Medicine, Humans, and 15 moreInternal Medicine, Articles, Female, Male, Registries, Clinical Sciences, Aged, Middle Aged, Retrospective Studies, Risk Factors, Professional Competence, Neurosciences, Postoperative Complications, Platelet Aggregation Inhibitors, and hazard ratio
1. AJNR Am J Neuroradiol. 1996 Aug;17(7):1384-7. Hypervascular tumor of the buccal space in an adult as a late recurrence of juvenile angiofibroma. Berger SB, Chaloupka JC, Putman CM, Citardi MJ, Lamb T, Sasaki CL. ...
Research Interests:
Research Interests:
To assess the feasibility, natural history, and preliminary physiologic validation of creating an in vivo arteriovenous malformation model in swine. A transorbital puncture technique into the cavernous sinus was used to create an... more
To assess the feasibility, natural history, and preliminary physiologic validation of creating an in vivo arteriovenous malformation model in swine. A transorbital puncture technique into the cavernous sinus was used to create an arteriovenous communication between the rostral rete and the cavernous sinus in eight swine. Short-term patency and hemodynamic behavior were assessed clinically and by serial angiography. Acute phase physiologic characterization of four models was also performed, using intravascular pressure and Doppler blood flow velocity measurements. Large arteriovenous shunts between the rostral rete and cavernous sinus were consistently produced, which mimicked the angiographic features of cerebral arteriovenous malformations in humans. Classic changes in intraarterial and intravenous pressures and blood flow velocities were also observed. Early pathophysiologic evolution occurred in two animals, consisting of recruitment of previously unseen collateral vessels. Spont...
Research Interests:
Research Interests:
We describe a case of an occult lateral temporal meningoencephalocele discovered in a 14-year-old boy during a work-up for minor head trauma. This spontaneous encephalocele resulted from a closure defect at the former sphenoidal... more
We describe a case of an occult lateral temporal meningoencephalocele discovered in a 14-year-old boy during a work-up for minor head trauma. This spontaneous encephalocele resulted from a closure defect at the former sphenoidal fontanelle. Preoperative MR images are presented.
Research Interests:
Research Interests:
A patient presented with transoral hemorrhage 3 months after CT-guided percutaneous biopsy of the masticator space, prompting concern about sentinel hemorrhage from impending carotid artery rupture related to prior radical head and neck... more
A patient presented with transoral hemorrhage 3 months after CT-guided percutaneous biopsy of the masticator space, prompting concern about sentinel hemorrhage from impending carotid artery rupture related to prior radical head and neck surgery and radiation therapy. Angiographic evaluation showed the internal carotid artery to be normal but demonstrated a pseudoaneurysm of the buccal branch of the internal maxillary artery exactly corresponding to the site of prior fine-needle biopsy.