Coronaric Stent-Graft Deployment in the Treatment of Carotid Blowout (Pampana, 2011)

Patient was admitted for massive pharyngeal hemorrhage, loss of consciousness and sphincter control. Angiography showed a severe narrowing of the left internal carotid artery and signs interpreted as bleeding from the left ECA branches. In addition, the angiography showed a reduced representation of left intracranial vessels without vascularization of the left ACA. Embolization of the small distal ECA branches was performed. Further angiography of the left external carotid artery was conducted highlighting media not coming from the distal ECA branches, so further left ICA angiography was performed. To control the hemorrhage and to restore a physiologic vessel patency with regular blood flow through the ICA, it was decided to deploy a covered stent graft. Originally a 6x20 mm Fluency stent was chosen, however it determined a high attrius with the vessel wall and to avoid an extension of the vessel laceration, it was decided to opt for a different stent with a lower profile and higher flexibility. A 6x15 mm Direct Stent was chosen. The stent was deployed at 6 atm successfully. An angiographic check revealed recovery of the vessel patency and blood flow, and the exclusion of the lacerated segment of the ICA with hemorrhage control, though a slight early venous filling and contrast material outlining the internal carotid artery along the skull base, due to iatrogenic dissection, persisted. Subsequent cerebral angiography showed an improvement in the perfusion of the MCA and its distal branches. As a clinical result, interruption of the rhinopharyngeal bleeding and normalization of the heart frequency and blood pressure was obtained, with resuscitation and stabilization of the patient’s condition.