Endovascular management of impending carotid rupture in a patient with advanced head and neck cancer.
OBJECTIVE
To describe an innovative endovascular technique combining a flexible self-expanding stent-graft to protect the common and internal carotid artery with selective coil embolization of the affected external carotid artery (ECA) branches.


METHODS
A 42-year-old man presented with episodes of profuse but self-limited carotid hemorrhage from advanced squamous cell carcinoma of the neck. Despite invasion of the carotid sheath by the tumor, angiography confirmed the source of bleeding to be invasion of branches of the ECA. Successful coil embolization of the ECA and stent-graft isolation of the common/internal carotid arteries were performed. At 1-month follow-up, carotid angiography confirmed the complete occlusion of the ECA and patent stent-graft. There was no recurrent bleeding or neurological deficits at 6 months after the procedure.


CONCLUSIONS
Stent-grafts in combination with coil embolization can be used to manage patients with impending carotid rupture secondary to head and neck cancer.
Bates
Mark C
MC
Department of Medicine, Robert C. Byrd Health Sciences Center, Charleston, West Virginia, USA. mark.bates@camc.org
Shamsham
Fadi M
FM
D000328:Adult; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation; D002294:Carcinoma, Squamous Cell / Q000150:complications*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004621:Embolization, Therapeutic; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D012422:Rupture, Spontaneous; D015607:Stents