Hemorrhagic Vocal Fold Inflammation Following Endotracheal Intubation in a Patient Undergoing Endovascular Neurosurgery Under Dual Antiplatelet Therapy: A Case Report
Masayoshi Koike, Takako Terui, Tomohiro Nakanishi, Risa Tuboi, Hiroyuki Enomoto, Toshihiro IshibashiBackground
Hemorrhagic vocal fold inflammation is an uncommon complication of endotracheal intubation. Its clinical course in patients receiving perioperative antithrombotic therapy remains unclear.
Case Presentation
A woman in her 60 s receiving dual antiplatelet therapy (DAPT) underwent endovascular neurosurgery with flow‐diverter stent deployment and coil embolization. Endotracheal intubation was uneventful, and cuff pressure was appropriately maintained. Hoarseness developed on postoperative day 1, and laryngoscopy on day 2 revealed hemorrhagic vocal fold inflammation. Intraoperative fluoroscopic images suggested proximal migration of the endotracheal tube, with possible changes in tube and cuff position that may have contributed to minor vocal fold mucosal injury. The symptoms improved with conservative management, and complete recovery was confirmed at 1 month.
Discussion
Hemorrhagic vocal fold inflammation occurred following apparently uneventful endotracheal intubation in a patient receiving perioperative antithrombotic therapy. Although the underlying mechanism remains uncertain, changes in endotracheal tube and cuff position during the procedure represent one possible contributing factor.