|Treatment of ruptured common carotid artery|
|- Operators: Seung-Whan Lee, MD|
|History and pre-intervention evaluation|
A 63-year-old female was admitted for radiofrequency catheter ablation (RFCA) to treat chronic atrial fibrillation. Her past medical history was hypertension and cerebrovascular accident 1 year ago and her current medication were warfarin, amiodarone, angiotension receptor blocker. She was alert and oriented. Ausculation of the neck showed normal carotid upstrokes.
A 7 Fr. sheath was inserted into the right femoral artery. Heparinization was performed during the intervention with the active clotting time being kept at about 250 to 300 seconds. A 5Fr. Headhunter diagnostic catheter (Cook, Bloomington, IN, USA) was placed in the right CCA. Angiography showed bleeding from the proximal right CCA (Figure 2A). A 0.035-inch stiff Amplatz wire (Cook, Bloomington, IN, USA) was used to exchange a 7Fr. Shuttle guide sheath (Cook, Bloomington, IN, USA) into the right CCA. The Shuttle guide sheath was positioned proximal to the right common carotid bifurcation. A Jostent peripheral stent graft (5 x 28 mm; Abbott, Illinois, USA) was hand mounted onto the Ultrathin diamond balloon catheter (6 x 40 mm; Boston Scientific, MA, USA). The stent-graft and balloon were advanced to the injured segment of the CCA (Figure 2B). The loaded balloon catheter was positioned at the level of the injured CCA. After a control angiogram was obtained, the stent-graft was inflated upto 15 atm (Figure 2C). The balloon was deflated while negative pressure was applied and then, the balloon was removed. A final angiogram showed total closure of the ruptured portions of the CCA (Figure 2D). The patient had no neurologic changes after the procedure. Follow-up CT suggested decreased the extent of hematoma around CCA and in the mediastinum in 5 days after procedure (Figure 3). She was discharged from hospital without any symptoms and complications.