Carotid blowout syndrome as a late complication of carotid stenting in irradiated neck: covered stent treatment using the “No-Touch” technique

Carotid blowout syndrome (CBS) is a potentially fatal condition requiring prompt diagnosis and intervention. CBS primarily affects patients with a history of surgery or irradiation for head and neck malignancies. In this report, we describe a case of CBS in which the carotid artery ruptured 2 months after carotid artery stenting in a patient with a previous history of surgery and irradiation for pharyngeal cancer. Although the distance between the orifice of the common carotid artery and the ruptured site was short, the "no-touch" technique-using the Newton-shaped stiff inner catheter (Newton-T®, Medikit) during the guiding catheter navigation-and snare fixation enabled a stable procedure. Two self-expanding covered stents (GORE® VIABAHN®, Gore) covered the ruptured site. Despite adverse conditions, the combination of these techniques led to effective management of impending CBS, a potentially fatal disease. This case report highlights the feasibility of covered stents for CBS and the techniques used for guiding catheter navigation and stabilization throughout the procedure.