Endovascular treatment of the carotid artery rupture with massive hemorrhage.
BACKGROUND
To assess the efficacy and safety of endovascular embolization in the treatment of the carotid artery rupture.


METHODS
A series of 21 patients who had carotid artery rupture (CAR) with massive transoronasal or transcervical hemorrhage, all treated with endovascular embolization, were reviewed. There were 17 males and 4 females ranging in age from 21 to 79 years, with a mean of 47 years. The predisposing factors of the CAR were head and neck tumors associated with surgical treatment and/or post-radiation therapy (n = 17), surgical complications (n = 1) and trauma (n = 3). Detachable balloons with liquid adhesives were used in 13 patients for vascular occlusion and obliteration of pseudoaneurysm of the internal or common carotid artery. Liquid adhesives and/or coils were used in 8 patients, in whom only the branches of the external carotid artery were involved (n = 6), or obliteration of a pseudoaneurysm with preservation of the ICA (n = 2).


RESULTS
Endovascular treatment was technically successful in all 21 cases of the CAR with cessation of profuse hemorrhage immediately after embolization. No recurrence of bleeding was observed. Two patients developed permanent hemiparesis several hours later after occlusion of the carotid artery (10%). Three patients had a transient ischemic attack; all returned to normal neurological conditions later (14%). Ten patients having advanced head and neck carcinoma died during follow-up period owing to the disease itself. Clinical follow-up period for these patients lasted 2 to 48 months, with a mean of 16 months.


CONCLUSIONS
Therapeutic endovascular embolization of the CAR is the primary invasive modality for treating CAR with profuse hemorrhage. It was proven both safe and effective over a relatively long follow-up period.
Luo
Chao-Bao
CB
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. cbluo@vghtpe.gov.tw
Chang
Feng-Chi
FC
Teng
Michael Mu-Huo
MM
Chen
Clayton Chi-Chang
CC
Lirng
Jiing-Feng
JF
Chang
Cheng-Yen
CY
D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000209:etiology / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous