Successful prevention of carotid artery rupture by placing a covered stent before salvage resection of advanced recurrent tongue cancer: a case report

Head and neck squamous cell carcinoma (HNSCC) is a common malignancy with a high recurrence rate, especially in locally advanced cases. Tumor invasion of the carotid artery is associated with poor prognosis and poses significant therapeutic challenges, with increased risks of fatal hemorrhage and stroke. Advances in endovascular and multidisciplinary approaches have expanded treatment options for such cases. We report a 39-year-old man with recurrent tongue squamous cell carcinoma encasing the left internal carotid artery after surgery and adjuvant chemoradiotherapy. A staged strategy was adopted: endovascular placement of a covered stent as hemorrhage prophylaxis followed by salvage resection with pectoralis major myocutaneous flap reconstruction. Initial angiography demonstrated preserved antegrade flow through the stent; approximately 6 months later, follow-up digital subtraction angiography showed in-stent occlusion with robust collateral perfusion via the anterior and posterior communicating arteries, without neurologic deficits. The patient recovered uneventfully and resumed normal daily activity. In carefully selected patients, a stent-as-bridge-to-surgery approach may mitigate perioperative hemorrhagic risk and enable definitive salvage resection. Given the potential for rebleeding, thrombosis, and infection, this strategy requires strict perioperative monitoring, infection control, tailored antithrombotic management, and individualized collateral assessment. As a single case, these observations warrant cautious interpretation.