Emergent endovascular treatment with direct carotid puncture for exsanguinating carotid blowout syndrome

Introduction: Carotid Blowout Syndrome (CBS) carries an exceedingly high mortality rate. Various established endovascular techniques are successful in treating less acute CBS, but exsanguinating patients with hemodynamic compromise continue to pose a significant clinical challenge. Methods: We report a 53-year-old male with squamous cell carcinoma of the anterior tongue presented with a sentinel hemoptysis followed by a massive oral hemorrhage. The patient suffered a cardiac arrest secondary to acute blood loss, from which he was successfully resuscitated. Results: An occlusion technique is presented involving direct carotid puncture for successful treatment of hemodynamically unstable, exsanguinating patients. Conclusion: This technique accomplishes rapid arrest of exsanguination, minimal hemorrhage site manipulation, and successful carotid occlusion.