Treatment of a patient with carotid blowout syndrome with a new deconstructive embolization technique

Abstract

Carotid blowout syndrome is a rare clinical conditions with a high mortality rate, especially in patients with head and neck tumors who have received radiotherapy and chemotherapy. We present our patient who had hemangioendothelioma of the neck for 5 years and therefore received radiotherapy, fistulized to the skin on the neck and active bleeding out of the fistula area. In the radiological imaging of the patient, vessel wall irregularities in the common carotid artery (CCA) and accompanying pseudoaneurysm with a diameter of 3 cm were detected, and endovascular treatment was performed. After the patient passed the balloon occlusion test, first the proximal internal carotid artery was closed with coils. Then, the balloon was inflated proximal to the CCA and a 10% diluted glue-lipiodol mixture was injected into the entire diseased CCA bed. Closure of the distal with coil and proximal with balloon prevented the risk of off-target embolization of the glue.

Keywords

• Carotid blowout syndrome
• Embolization
• N-butyl cyanoakrylate