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A Rebleeding Case of Carotid Blowout Syndrome after Endovascular Treatment with Covered Stent Yujiro TANAKA 1 , Takao HASHIMOTO 1 , Tomoya YOKOYAMA 1 , Yusuke ARAI 1 , Muneaki KIKUNO 2 , Hiroki SATO 3 , Kiyoaki TSUKAHARA 3 , Michihiro KOHNO 1 1Department of Neurosurgery, Tokyo Medical University Hospital 2Department of Neurology, Tokyo Medical University Hospital 3Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hospital Keyword: carotid blowout syndrome , covered stent , rebleeding , endovascular treatment pp.935-940
Published Date 2020/10/10
DOI https://doi.org/10.11477/mf.1436204299
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 We present a case of a patient who survived carotid blowout syndrome(CBS)due to covered stent placement, but bled again 34 days later. A 67-year-old man with laryngeal cancer experienced cardiac arrest due to carotid blowout a day after he underwent the balloon occlusion test and abnormal feeder embolization of the tumor. After quick resuscitation, he was treated with endovascular therapy using a covered stent, since he had insufficient cerebral ischemic tolerance. We succeeded in stent placement and the bleeding stopped without any procedural complications. The patient survived after the procedure. However, bleeding recurred when a nasal endoscope was inserted 34 days later. The rupture point was immediately distal of the stent. We performed carotid artery occlusion with coils and n-butyl-cyanoacrylate. The patient survived, but his condition gradually weakened and died 97 days after stenting. Emergency hemostasis for carotid blowout using a covered stent is the only available treatment for patients who do not have sufficient cerebral ischemic tolerance. However, this procedure has a higher rate of re-bleeding than carotid artery occlusion. Moreover, it is an off-label treatment in Japan. Therefore, possible treatments for CBS including use of covered stent or treatments for non-ruptured CBS should be analyzed in the future.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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