Endovascular management of carotid blowout

To highlight pertinent aspects of emergent endovascular management of carotid rupture, or carotid blowout syndrome (CBS), an emergent, life-threatening complication of head and neck cancer and its treatments.

A retrospective chart review was conducted of all patients with carotid blowouts at the authors' institution from 2008-2010. A systematic literature review was also performed.

Eight patients (three women and five men) with an average age of 61 years (range 47-78 years) were reviewed. Seven patients had a positive history for squamous cell carcinoma of the neck, and five patients had active malignant disease. Carotid arterial deconstruction using liquid embolic material, coil embolization, or both achieved immediate hemostasis in every case (100%). No patients died as a result of their initial hemorrhage, but one patient had lethal hemorrhage at 1 day postoperatively. Two patients experienced nonlethal postoperative complications. At an average follow-up of 3 months (range<1-8 months), three patients were alive, three had died as a result of their underlying disease, and two had died of other causes.

The treatment of patients with terminal malignant disease and CBS should provide maximum relief and minimize the risks of repeat surgery, morbidity, and mortality. Endovascular management of CBS with deconstructive techniques achieves immediate hemostasis and definitive treatment. The risks of intraoperative mortality and recurrent hemorrhage are low.