Percutaneous thrombin injection of common carotid artery pseudoaneurysm without cerebral protection

An 83-year-old man with sepsis sustained right common carotid artery injury during attempted central-line placement. A computed tomographic scan showed a large hematoma in the patient's neck and a carotid pseudoaneurysm. His clinical condition was such that transfer to the interventional suite was judged unsafe. Percutaneous thrombin injection was performed at the bedside under ultrasonographic guidance, but without protective temporary balloon occlusion. The procedure was successful, with no neurologic complications. At follow-up ultrasonographic evaluation, there was complete and sustained occlusion of the pseudoaneurysm.Emergent percutaneous treatment of common carotid artery pseudoaneurysm can be performed without temporary balloon occlusion for cerebral protection-in extreme circumstances, and at unknown risk.