Abstract No. 417: Endovascular treatment for acute carotid blow-out with massive hemorrhage

Abstract

Carotid blowout is a devastating complication in patients who have had trauma, radiation induced necrosis, recurrent head and neck malignancy, wound complications or pharyngo-cutaneous fistulas. A covered stent offers an alternative to treatment of a carotid blowout patient thought to be at high risk for surgery or carotid occlusion. Stent placement in the common carotid artery or carotid bulb is a technically challenging because of large luminal diameter and luminal caliber discrepancy between internal carotid artery and common carotid artery. We present four patients with common carotid rupture and massive bleeding who were treated with self-expanding covered stents and coiling. A 44 year old male patient presenting with profuse internal and external bleeding from a right carotid blow-out due to metastatic infiltration secondary to primary squamous cell carcinoma of the tongue. A 69 year old female patient presenting with acute bleeding from the neck with skin erosins. A 20-year-old male presenting with a stab wound to the neck. And finally a 57 year old male presenting with acute bleeding secondary to treated squamous cell carcinoma. The main indications for the type of treatment of Carotid blow-out Syndrome are location, cause, hemorrhage and angiography. Patients with negative angiography need only appropriate wound care. However patients with positive angiography are candidates for vessel occlusion, stent graft, embolization or anti-coagulation. Indications for treating Carotid blow-out syndrome complicated by dissection are also different. The placement of stent grafts or embolization in patients with active bleeding from Carotid Blow-out is a feasible and successful approach to ending acute bleeding with minimal morbidity compared to ligation of the artery. We have developed an algorithm for the proper treatment of the different types of Carotid blow-out syndrome.