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Marilyn C. Zimmerman, MD; Robert A. Mickel, MD, PhD; David J. Kessler, MD; C. Mark Mehringer, MD; Grant B. Hieshima, MD; Thomas C. Calcaterra, MD

Arch Otolaryngol Head Neck Surg. 1987;113(11):1169-1175.

Abstract
• Acute carotid artery rupture is frequently heralded by prodromal arterial bleeding. This warning signal provides the physician with a brief interval in which to hemodynamically stabilize a patient, electively occlude the carotid, and consequently improve the patient's chance of survival. For three years, we have employed an initial nonoperative approach to patients with impending carotid rupture. A trial of endovascular balloon occlusion followed by detachable balloon embolization of the carotid artery has been utilized. Patients unable to tolerate temporary occlusion underwent a vascular bypass procedure followed by embolization. Six patients have undergone this approach, and all had permanent cessation of bleeding. None died as a result of the procedures. One patient developed permanent neurologic deficits. Balloon embolization offers improved results over elective ligation and should be considered as an alternative treatment for patients in this dire predicament.

(Arch Otolaryngol Head Neck Surg 1987;113:1169-1175)

Author Affiliations
From the Division of Head and Neck Surgery, UCLA School of Medicine (Drs Zimmerman, Mickel, Kessler, and Calcaterra), the Department of Radiology, Harbor–UCLA Medical Center (Dr Mehringer), and the Department of Radiology, University of California, San Francisco (Dr Hieshima).

Footnotes
Accepted for publication June 18, 1987.

Read before the American Society for Head and Neck Surgery, Denver, April 28, 1987.

Reprint requests to Division of Head and Neck Surgery, UCLA School of Medicine, CHS 62-202, 10833 LeConte Ave, Los Angeles, CA 90024 (Dr Zimmerman).

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