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Management of carotid artery rupture by monitored endovascular therapeutic occlusion (1988-1994)
M J Citardi1, J C Chaloupka, Y H Son
1Department of Surgery, Yale University School of Medicine, New Haven, Conn 06520-8041, USA.
Insights
Carotid rupture, a serious complication in head and neck surgery, has high mortality. Endovascular detachable balloon occlusion significantly improved patient outcomes, reducing neurologic sequelae in patients with carotid rupture.
Area of Science:
- Vascular Surgery
- Head and Neck Surgery
- Interventional Radiology
Background:
- Carotid rupture presents a significant clinical challenge with high mortality (40%) and neurologic morbidity (25%).
- Etiologies include radical surgery, radiation therapy, wound complications, and recurrent or persistent carcinoma.
- Traditional management strategies have yielded suboptimal outcomes.
Purpose of the Study:
- To evaluate the efficacy of endovascular detachable balloon occlusion for carotid rupture.
- To analyze the changing characteristics and outcomes of carotid rupture in head and neck surgery.
- To assess the impact of endovascular techniques on patient survival and neurologic sequelae.
Main Methods:
- Retrospective review of 18 carotid ruptures in 15 patients between January 1, 1988, and June 30, 1994.
- Identification of etiologic factors contributing to carotid rupture.
- Application and assessment of endovascular detachable balloon occlusion techniques introduced in 1991.
Main Results:
- 15 out of 18 patients (83.3%) survived their carotid rupture.
- No major neurologic sequelae were observed in the 15 surviving patients.
- All 12 patients treated with endovascular balloon occlusion since 1991 survived without significant neurologic sequelae.
Conclusions:
- Endovascular detachable balloon occlusion is a highly effective treatment for carotid rupture.
- This technique significantly reduces mortality and neurologic morbidity associated with carotid rupture.
- Endovascular approaches represent a major advancement in managing carotid rupture in head and neck surgery.
Abstract:
The reported mortality (40%) and neurologic morbidity (25%) rates for carotid rupture remain unacceptably high. This study was conducted to assess the impact of endovascular detachable balloon occlusion and the changing characteristics of carotid rupture in head and neck surgery. Between January 1, 1988, and June 30, 1994, 18 carotid ruptures were identified in 15 patients. Etiologic factors included radical surgery, radiation therapy, wound complications, and recurrent or persistent carcinoma. In 15 of 18 instances of carotid rupture, patients survived without major neurologic sequelae. After the introduction of endovascular techniques in 1991, the 12 patients whose hemorrhage was definitively managed through permanent balloon occlusion survived without significant neurologic sequelae. Endovascular occlusion techniques in the monitored patient may significantly improve the outcome after carotid rupture.