Endovascular treatment of spontaneous carotid bifurcation rupture

Background: Spontaneous rupture of the extracranial carotid artery is exceedingly rare and life-threatening. Most cases follow prior surgery, irradiation, or malignant invasion; truly spontaneous rupture is exceptional and poorly characterized, highlighting the need for clear diagnostic and therapeutic strategies. Case Presentation: An 89-year-old woman presented with a three-day history of sudden, painless right-sided neck swelling. Her past medical history included hypertension, senile dementia, and post-surgical hypothyroidism. Examination revealed a pulsatile hematoma without airway compromise. Computed Tomography Angiography (CTA) demonstrated a partially organized hematoma with active inflow from the right common carotid artery. Initial treatment consisted of a self-expanding Xact carotid stent (8 × 6 × 40 mm). On post-operative day one, she developed desaturation and airway narrowing. Ultrasonography confirmed pseudoaneurysm expansion. Urgent retreatment was performed with two Bentley BeGraft covered stents (7 × 27 mm and 7 × 37 mm) and surgical evacuation of the hematoma. Outcome and Follow-Up: Her course was notable for anemia requiring transfusion but was otherwise noneventful. She was discharged on dual antiplatelet therapy and corticosteroids. At one-month follow-up, recovery was uncomplicated with patent stents and no rebleeding. Conclusions: Spontaneous carotid rupture is a vascular emergency, entailing prompt airway management and endovascular flow control. Covered stents can preserve carotid flow but require close surveillance, especially in the first 48 post-operative hours. This case emphasizes the absence of standardized guidelines and the need for vigilant monitoring and individualized management.