Covered stent graft for treatment of a pseudoaneurysm and carotid blowout syndrome

Abstract

Background: Carotid blowout syndrome with pseudoaneu-
rysm, a rapidly progressive pathology, may present emer-
gently with massive oral hemorrhage. Use of an endograft
prosthesis offers a treatment strategy with salvation of the
carotid artery.
Case History: A 55 year old man with advanced squamous
cell carcinoma of the head and neck presented with recurrent
transoral hemorrhage, requiring endovascular treatment.
Technical Report: Coil embolization was initially performed
with little impact on the hemorrhage. A 7 x 40 mm Fluency®
Plus covered stent (Bard Peripheral Vascular, Tempe, Ari-
zona, USA) was placed and was supplemented by a second 8
x 40 mm Fluency Plus stent, with resulting cessation of active
contrast extravasation.
Discussion: The risks and benefits of various treatment op-
tions of carotid pseudoaneurysm with blowout are discussed
including the use or omission of antiplatelet and anticoagu-
lant regimens, with reference to previously reported cases.
Conclusion: Tandem, overlapping covered stent placement in
the common carotid artery is feasible and offers a treatment
option for carotid blowout syndrome. Risks of aggravation of
hemorrhage versus long-term thromboembolic events with-
out antiplatelet therapy must be considered in cases of active
ongoing hemorrhage.
Keywords: stent graft, pseudoaneurysm, carotid blowout
syndrome