MANAGEMENT OF CAROTID-ARTERY RUPTURE BY MONITORED ENDOVASCULAR THERAPEUTIC OCCLUSION (1988-1994)

The reported mortality (40%) and neurologic morbidity (25%) rates for carotid rupture remain unacceptably high. This study was conducted to assess the impact of endovascular detachable balloon occlusion and the changing characteristics of carotid rupture in head and neck surgery. Between January 1, 1988, and June 30, 1994, 18 carotid ruptures were identified in 15 patients. Etiologic factors included radical surgery radiation therapy, wound complications, and recurrent or persistent ca rcinoma. In 15 of 18 instances of carotid rupture, patients survived w ithout major neurologic sequelae. After the introduction of endovascul ar techniques in 1991, the 12 patients whose hemorrhage was definitive ly managed through permanent balloon occlusion survived without signif icant neurologic sequelae. Endovascular occlusion techniques in the mo nitored patient may significantly improve the outcome after carotid ru pture.