Emergent Endovascular Parent Artery Occlusion for Type III Carotid Blowout Syndrome After Charged Particle Therapy for Recurrent Maxillary Carcinoma: A Case Report and Literature Review.

Carotid blowout syndrome (CBS) refers to involvement of the carotid artery by malignant processes of the head and neck with compromise of vessel integrity and rupture. Carotid hemorrhage (CBS type III) is fatal, particularly when it occurs outside hospital settings. Bleeding can occur through the skin or mucosa and may cause airway compromise. It is associated with high mortality and morbidity. A 55-year-old woman presented to the emergency room with shock state, bleeding from the oral and nasal cavity. The patient had previously experienced recurrent maxillary carcinoma treated with radiation therapy 9 years prior. Digital subtraction angiography revealed active extravasation from the cavernous portion of the left internal carotid artery. Emergent parent artery occlusion was performed by coil embolization, including the extravasation site; complete hemostasis was achieved. Endovascular parent artery occlusion (PAO) is the preferred management method; covered stents are an option for managing patients who are not candidates for PAO. In our case, additional left superficial and middle cerebral artery anastomoses were needed on the day after PAO for preventing hemodynamic cerebral infarction. Since type III CBS can be fatal, early recognition of CBS predictors by multidisciplinary teams is crucial for preventing fatal bleeding.