Abstract Number ‐ 67: A case of Carotid blowout syndrome, case report, and review.

Abstract

Introduction Carotid blowout syndrome (CBS) is a potentially fatal carotid artery rupture. It is an unforeseen complication during mechanical thrombectomy that can be catastrophic without timely diagnosis and intervention. CBS develops when a damaged arterial wall cannot sustain its integrity, especially in patients who have undergone surgery or radiotherapy due to cancer. Carotid blowout syndrome is classified as threatened (type1), impending (type2), and acute (type3). Endovascular techniques have emerged as preferable alternatives to surgical ligation for treatment of CBS. Previous systemic reviews and meta‐analyses demonstrated that both coil embolization and stent grafting may be safe treatment options for CBS. This case study aims to show that early detection and endovascular management with transient distal balloon occlusion and stenting are lifesaving measures. Methods Case‐report Results Case presentation: 60‐year‐old male with past medical history of lung cancer s/p chemotherapy and radiation, hypertension, and methamphetamine abuse presented with left‐sided weakness and dysarthria, onset was 2 hours prior to arrival, his NIHSS was 11, CT head was negative for hemorrhage, CT angiogram of head and neck showed tandem occlusion of right ICA and right MCA bifurcation, he was in window for intravascular thrombolysis without contraindication, so he received Alteplase, he was brought into Angio‐suite for mechanical thrombectomy, On Right CCA injection there was complete occlusion of Right ICA with TICI‐0 flow, distal branches of Right ACA and MCA were not visualized. Mechanical thrombectomy was done on Right ICA and Right MCA. During clot retrieval, flow arrest was achieved by inflating the balloon guide with diluted contrast. Post thrombectomy there was extravasation around the right CCA and ICA, so the balloon guide was reinflated to have a florist around the catheter and hemostasis in the right ICA, two carotid stents were deployed sequentially with rapid exchange technique with overlapping technique, an endovascular graft was introduced and deployed at mid cervical segment at the point of leak and dissection. Post mechanical thrombectomy, TICI‐3 flow in the right ICA, and MCA were achieved, the patient was discharged to rehab in a stable condition on dual antiplatelet regimen. Conclusions CBS is a rare complication during mechanical thrombectomy, early and aggressive intervention in CBS is crucial to prevent devastating consequences, Transient balloon occlusion distal to the carotid blowout of the ICA is a reasonable technique for completing endovascular management with stenting.