Carotid blow out syndrome (CBOS) is a catastrophic emergency associated with extremely high morbidity and mortality. The usual causes of CBOS are post operative, inflammation, traumatic events, and head and neck malignant tumor invasion. The conventional surgical management is fraught with high morbidity, mortality and complication rates and is ineffective in many cases. The usual surgical treatment includes carotid artery and/or branch ligation. Carotid artery bypass has been performed with limited success. With the advent of uncovered and covered stents, the emergent management of CBOS...

During the last three years, we have studied 12 patients (men and women of middle and advanced age) with CBOS of different etiologies who were considered difficult or not manageable by emergency surgery. Insertion of different types of covered stents, both self-expanding and balloon-expandable: Gore Viabahn® Endoprosthesis, iCast™ (Atrium) covered stent, and Fluency® Plus Stent-Graft (Bard) and Wallstent (Boston Scientific) and Protégé (Bard).

All procedures were done in the interventional radiology suite and were successful in controlling the CBOS. No major complications related to the procedures were encountered. No arterial rupture, occlusion, thrombosis, stroke or infection resulted in a short follow up.

Emergent insertion of covered and uncovered stents is a safe, effective and easy procedure to temporarily manage CBOS in its desperate clinical setting. A longer follow-up and more patients treated are necessary to evaluate the long-term role of stenting in CBOS. CBOS is a catastrophic emergency associated with a prohibitive morbidity and mortality. The “conventional” surgical treatment is difficult and ineffective. Endovascular treatment with self-expanding or balloon-expandable covered stents must be considered the “first choice” in desperate situations.

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