Management of spontaneous carotid artery rupture: navigating life-threatening challenges and persistent risks

Abstract

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.