Endovascular Treatment of Carotid Blowout Syndrome



      Carotid blowout syndrome (CBS) is a life-threatening disease characterized by compromise of the carotid artery by head and neck cancer (HNC).

      Materials and methods

      We reviewed the characteristics and outcomes of all patients with carotid blowout syndrome who were treated between April 2010 and December 2019. Twelve patients with a history of HNC and radiation therapy were investigated. The balloon occlusion test (BOT) was performed in all patients to confirm collateral circulation. We placed a stent in patients who were intolerant to the BOT.


      The patients’ ages ranged from 50 to 81 years (mean: 68.1 years). Therapeutic occlusion of the affected internal carotid artery was performed in nine patients, while stenting was performed in three patients. Immediate hemostasis was achieved in all patients. Patients treated using stents were administered perioperative DAPT. One patient experienced rebleeding after surgery. Two patients had procedure-related cerebral infarctions. One patient died, but the others survived without major neurological deficits. One patient had persistent aneurysm after surgery that resolved over time.


      Endovascular treatment via occlusion or stent-based reconstruction of the internal carotid artery resulted in immediate hemostasis. Carotid occlusion and covered stent application are safe and efficient techniques to treat CBS secondary to HNC. Surgeons may obtain better outcomes if they perform BOT before occlusion and design treatment accordingly.

      Key Words


      CBS (Carotid blowout syndrome), HNC (Head and neck cancer), BOT (Balloon occlusion test), DSA (Digital subtraction angiography), CT (Computed tomography), ICA (Internal carotid artery), CCA (Common carotid artery)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lee A.W.
        • Law S.C.
        • Foo W.
        Nasopharyngeal carcinoma: local control by megavoltage irradiation.
        Br J Radiol. 1993; 66: 528-536
        • McDonald M.W.
        • Moore M.G.
        • Johnstone P.A.
        Risk of carotid blowout after reirradiation of the head and neck: a systematic review.
        Int J Radiat Oncol Biol Phys. 2012; 82: 1083-1089
        • Chaloupka J.C.
        • Putman C.M.
        • Citardi M.J.
        • Ross D.A.
        • Sasaki C.T.
        Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: diagnostic and managerial considerations.
        AJNR Am J Neuroradiol. 1996; 17: 843-852
        • Macdonald S.
        • Gan J.
        • Mckay A.J.
        • Edwards R.D.
        Endovascular treatment of acute carotid blow-out syndrome.
        J Vasc Interv Radiol. 2000; 11: 1184-1188
        • Moore O.S.
        • Karlan M.
        • Sigler L.
        Factors influencing the safety of carotid ligation.
        Am J Surg. 1969; 118: 666-668
        • Razack M.S.
        • Sako K.
        Carotid artery hemorrhage and ligation in head and neck cancer.
        J Surg Oncol. 1982; 19 (189-192.2,3)
        • Osguthorpe J.D.
        • Hungerford G.D.
        Transarterial carotid occlusion: case report and review of the literature.
        Arch Otolaryngol. 1984; 110: 694-696
        • Warren F.M.
        • Cohen J.I.
        • Nesbit G.M.
        • Barnwell S.L.
        • Wax M.K.
        • Andersen P.E.
        Management of carotid “blowout” with endovascular stent grafts.
        Laryngoscope. 2002; 112: 428-433
        • Hoppe H.
        • Barnwell S.L.
        • Nesbit G.M.
        • Petersen B.D.
        Stent-grafts in the treatment of emergent or urgent carotid artery disease: review of 25 cases.
        J Vasc Interv Radiol. 2008; 19: 31-41
        • Zussman B.
        • Gonzalez L.F.
        • Dumont A.
        Endovascular management of carotid blowout.
        World Neurosurg. 2012; 78: 109-114
        • Tsang A.C.
        • Leung K.M.
        • Lee R.
        Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the pipeline embolization device.
        J Neurointerv Surg. 2015; 7: 603-607