Asymptomatic Spontaneous Extrusion of a Carotid Artery Stent 2 Months Post-Placement in a Radiated Neck

Carotid blowout syndrome (CBS) is a rare but potentially fatal complication of head and neck cancer (HNC), with radiotherapy being a major risk factor. Because of its high mortality, urgent treatment is essential. Endovascular therapy has become the standard approach, although complications such as stent extrusion may occur.

This study reports a single case with a brief review of the relevant literature.

A 67-year-old woman underwent neck dissection and chemoradiotherapy for metastatic cervical carcinoma. Radiation dermatitis developed during treatment and persisted thereafter. Four months later, she developed a carotid artery pseudoaneurysm that resulted in CBS. Emergency endovascular repair was performed using a covered stent from the left common to internal carotid artery. Two months later, the stent spontaneously extruded through the cervical skin. Remarkably, there was no active bleeding or neurological deficit. The stent detached naturally, and the patient remained clinically stable.

This case highlights an extremely rare occurrence of carotid stent extrusion. Although endovascular therapy is effective for CBS, serious complications such as hemorrhage and neurological damage may occur. Careful long-term follow-up is essential to detect delayed adverse outcomes.Clinical ImpactThis case highlights a rare but clinically important phenomenon of spontaneous carotid stent extrusion following endovascular treatment for carotid blowout syndrome (CBS). While endovascular therapy is widely accepted as the first-line treatment due to its minimally invasive nature, this report emphasizes the potential for delayed and unexpected complications, particularly in irradiated and infected fields. The absence of hemorrhagic or neurological sequelae despite stent extrusion suggests that complete thrombosis and collateral circulation may mitigate catastrophic outcomes. Clinicians should recognize this risk and implement close multidisciplinary follow-up, early wound management, and consider preventive strategies such as flap reconstruction or timely stent removal to improve patient safety.