Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risks
BACKGROUND: Carotid pseudoaneurysms are extremely rare, and their inherent instability and unpredictability require prompt evaluation and intervention to mitigate potential neurological complications or prevent life-threatening bleeding and airway obstruction. We present a case report of spontaneou...
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| Language: | Portuguese |
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular
2025-04-01
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| Series: | Angiologia e Cirurgia Vascular |
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| Online Access: | https://acvjournal.com/index.php/acv/article/view/607 |
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| author | Andreia Pinelo Daniel Mendes Joana Martins Samuel Cardoso Rui Machado |
| author_facet | Andreia Pinelo Daniel Mendes Joana Martins Samuel Cardoso Rui Machado |
| author_sort | Andreia Pinelo |
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BACKGROUND: Carotid pseudoaneurysms are extremely rare, and their inherent instability and unpredictability require prompt evaluation and intervention to mitigate potential neurological complications or prevent life-threatening bleeding and airway obstruction. We present a case report of spontaneous internal carotid artery (ICA) rupture.
CASE REPORT: An eighty-eight-year-old male with a history of non-Hodgkin lymphoma and adenocarcinoma of the rectum presented with a spontaneous rupture of the left ICA. Bleeding control was achieved by deploying a 7mm self-expandable stent graft (Viabhan®) in the ICA through a transcervical approach. Control computed tomography angiography at 24 hours revealed a "type 1 endoleak" with contrast leak filling from the proximal landing zone. A transfemoral approach was used for external carotid artery ostial occlusion using an 8mm vascular plug, followed by stent graft extension to the common carotid artery. Blood cultures were positive for Pseudomonas aeruginosa and the patient completed nine weeks of directed antibiotic therapy. There was a recurrence of rupture by the 5th month of follow-up, controlled once again with a distal extension with an 8mm Viabahn®. The patient died on the 7th postoperative day due to nosocomial pneumonia.
CONCLUSION: This report highlights the complexity of managing carotid ruptures and pseudoaneurysms, emphasizing the potential of endovascular therapy to reduce morbidity. While endovascular treatment is a viable option for frail patients, considering long-term implications is essential. Balancing short-term benefits with potential medium- and long-term complications remains critical to the decision-making process.
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| format | Article |
| id | doaj-art-1e9b97b3125b44a5bb1be164555ddbbf |
| institution | OA Journals |
| issn | 1646-706X 2183-0096 |
| language | Portuguese |
| publishDate | 2025-04-01 |
| publisher | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| record_format | Article |
| series | Angiologia e Cirurgia Vascular |
| spelling | doaj-art-1e9b97b3125b44a5bb1be164555ddbbf2025-08-20T02:15:41ZporSociedade Portuguesa de Angiologia e Cirurgia VascularAngiologia e Cirurgia Vascular1646-706X2183-00962025-04-0120410.48750/acv.607Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risksAndreia Pinelo0Daniel Mendes1Joana Martins2Samuel Cardoso3Rui Machado4Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo AntónioDepartment of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo AntónioDepartment of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo AntónioDepartment of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo AntónioDepartment of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António BACKGROUND: Carotid pseudoaneurysms are extremely rare, and their inherent instability and unpredictability require prompt evaluation and intervention to mitigate potential neurological complications or prevent life-threatening bleeding and airway obstruction. We present a case report of spontaneous internal carotid artery (ICA) rupture. CASE REPORT: An eighty-eight-year-old male with a history of non-Hodgkin lymphoma and adenocarcinoma of the rectum presented with a spontaneous rupture of the left ICA. Bleeding control was achieved by deploying a 7mm self-expandable stent graft (Viabhan®) in the ICA through a transcervical approach. Control computed tomography angiography at 24 hours revealed a "type 1 endoleak" with contrast leak filling from the proximal landing zone. A transfemoral approach was used for external carotid artery ostial occlusion using an 8mm vascular plug, followed by stent graft extension to the common carotid artery. Blood cultures were positive for Pseudomonas aeruginosa and the patient completed nine weeks of directed antibiotic therapy. There was a recurrence of rupture by the 5th month of follow-up, controlled once again with a distal extension with an 8mm Viabahn®. The patient died on the 7th postoperative day due to nosocomial pneumonia. CONCLUSION: This report highlights the complexity of managing carotid ruptures and pseudoaneurysms, emphasizing the potential of endovascular therapy to reduce morbidity. While endovascular treatment is a viable option for frail patients, considering long-term implications is essential. Balancing short-term benefits with potential medium- and long-term complications remains critical to the decision-making process. https://acvjournal.com/index.php/acv/article/view/607Carotid pseudoaneurysmcarotid ruptureendovascularstent graft |
| spellingShingle | Andreia Pinelo Daniel Mendes Joana Martins Samuel Cardoso Rui Machado Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risks Angiologia e Cirurgia Vascular Carotid pseudoaneurysm carotid rupture endovascular stent graft |
| title | Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risks |
| title_full | Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risks |
| title_fullStr | Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risks |
| title_full_unstemmed | Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risks |
| title_short | Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risks |
| title_sort | management of spontaneous carotid artery rupture navigating life threatening challenges and persistent risks |
| topic | Carotid pseudoaneurysm carotid rupture endovascular stent graft |
| url | https://acvjournal.com/index.php/acv/article/view/607 |
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