Two cases of emergent endovascular treatment for carotid blowout syndrome after free flap reconstruction for neck cancer

Abstract 

Carotid blowout is a devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. For patients with bleeding originating in the internal or common carotid artery, treatment options are limited. These include the endovascular remodelling strategies using a stent or embolization of the aneurysm with coils.

We describe two cases of pseudoaneurysmal rupture in the common carotid artery with massive bleeding in patients with head and neck malignancies and a history of long-term radiation treatment. They underwent immediate coil embolization and wall stent deployment and, which resulted in the successful control of bleeding. Although these endovascular treatments often result in recurrent carotid blowout syndrome, they can be useful and effective in treating emergent carotid rupture in patients for whom balloon occlusion test is contraindicated.

Keywords: Carotid blowout syndrome, Endovascular treatment, Coil embolization, Wall stent deployment