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OBJECTIVE: Management of arterial hemorrhage from disease or injury involving the carotid, subclavian and vertebral arteries can present a complex clinical dilemma. The open surgical approach may involve technical challenges for obtaining proximal and distal control and effecting repair while maintain perfusion and has been associated with significant morbidity. Endovascular techniques including balloon occlusion, coil embolization and covered stent placement may simplify the management of these patients. We review our experience over the past 10 years using endovascular techniques in managing patients with a variety of pathologic, iatrogenic and traumatic injuries in these vascular beds.
METHODS: We review our experience with endovascular management of carotid, subclavian and vertebral hemorrhage. Thirteen cases are reported with outcomes. Technical challenges associated with coil embolization and stent graft placement are outlined.
RESULTS: Of the 13 cases reviewed, we had 100% technical success in placing endovascular coils and stent grafts. One patient had asymptomatic, distal laminal thrombus identified in the proximal stent graft at 11 months treated with covered stent placement. One patient had asymptomatic late stent thrombosis. Hemostasis was obtained in all patients.
CONCLUSION: We describe the technical challenges and outcomes in the successful treatment of acute iatrogenic, oncologic and traumatic carotid hemorrhage by endovascular intervention. Percutaneous modalities utilized include coil embolization and covered stents with 100% technical success and no associated cerebral vascular accident (CVA) or acute stent thrombosis.