C a rotid ar tery rup ture (CAR) is a di sas trous event presenting itself as an episode of acute profuse transoronasal or transcervical bleed ing. It oc curs as a com pli ca tion in 3 to 5% cases of ma jor head and neck re - section, 1 and in cases of unresectable tu mor af ter ra di a- tion ther apy. Re ported out comes var ied widely, the av er - age es ti mate of cu mu la tive mor tal ity of 40% and ma jor neu ro log i cal def i cit of 60% were re ported. 2-5 Be fore the ad vent of the endovascular embolization, the sur geon usu ally had no al ter na tive but to per form emer gent li ga - tion of the in volved ar tery to con trol the CAR with mas- sive bleed ing. The sur gi cal li ga tion of the ca rotid ar tery car ries a mor tal ity from 32% to 77%. 2,6-9 A sig nif i cant pro por tion of sur vi vors, 12% to 50% of the cases, ex pe ri - ence per ma nent neu ro log i cal sequelae. 2,6-9 Over the past sev eral years, the endovascular embolization has dem on - strated con sid er able prom ise in the man age ment of cer - tain oronasal hem or rhages. 10-12 The pur pose of this pa per is to pres ent our ex pe ri ence of man ag ing 21 pa tients with CAR with pro fuse hem or rhage in an ef fort to de fine the role of angiography and to as sess the ef fi cacy and safety of endovascular embolization in the treat ment of the CAR. METHODS From 1996 to 2001, 21 pa tients were re ferred to our De part ment for di ag nos tic angiography and endovascular 140 J Chin Med Assoc 2003;66:140-147 Chao-Bao Luo 1 Feng-Chi Chang 1 Mi chael Mu-Huo Teng 1 Clay ton Chi-Chang Chen 2 Jiing-Feng Lirng 1 Cheng-Yen Chang 1 De part ment of Ra di ol ogy, 1 Tai pei Vet erans Gen eral Hos pi tal and 2 Taichung Vet erans Gen eral Hos pi tal; Na tional Yang-Ming Uni ver sity School of Med i cine, Tai pei, Tai wan, R.O.C. Key Words carotid ar ter ies; embolization; rup ture; therapeutic Orig i nal Article Endovascular Treatment of the Carotid Artery Rupture with Massive Hemorrhage Background. To as sess the ef fi cacy and safety of endovascular embolization in the treat ment of the ca rotid ar tery rup ture. Methods. A se ries of 21 pa tients who had ca rotid ar tery rup ture (CAR) with mas sive transoronasal or transcervical hem or rhage, all treated with endovascular embol - ization, were re viewed. There were 17 males and 4 fe males rang ing in age from 21 to 79 years, with a mean of 47 years. The pre dis pos ing fac tors of the CAR were head and neck tu mors as so ci ated with sur gi cal treat ment and/or post-radiation ther apy (n = 17), sur gi cal com pli ca tions (n = 1) and trauma (n = 3). De tach able bal loons with liq - uid ad he sives were used in 13 pa tients for vas cu lar oc clu sion and oblit er a tion of pseudoaneurysm of the in ter nal or com mon ca rotid ar tery. Liq uid ad he sives and/or coils were used in 8 pa tients, in whom only the branches of the ex ter nal ca rotid ar tery were in volved (n = 6), or oblit er a tion of a pseudoaneurysm with pres er va tion of the ICA (n = 2). Results. Endovascular treat ment was tech ni cally suc cess ful in all 21 cases of the CAR with ces sa tion of pro fuse hem or rhage im me di ately af ter embolization. No re - cur rence of bleed ing was ob served. Two pa tients de vel oped per ma nent hemiparesis sev eral hours later af ter oc clu sion of the ca rotid ar tery (10%). Three pa tients had a tran sient ischemic at tack; all re turned to nor mal neu ro log i cal con di tions later (14%). Ten pa tients hav ing ad vanced head and neck car ci noma died dur ing fol low-up pe riod ow ing to the dis ease it self. Clin i cal fol low-up pe riod for these pa tients lasted 2 to 48 months, with a mean of 16 months. Conclusions. Ther a peu tic endovascular embolization of the CAR is the pri mary in - va sive mo dal ity for treat ing CAR with pro fuse hem or rhage. It was proven both safe and ef fec tive over a rel a tively long fol low-up pe riod. Re ceived: May 23, 2002. Ac cepted: November 11, 2002. Cor re spon dence to: Chao-Bao Luo, MD, De part ment of Ra di ol ogy, Tai pei Vet erans Gen eral Hospital, 201, Sec. 2, Shih-Pai Road, Tai pei 112, Tai wan. Fax: +886-2-2875-7348; E-mail: cbluo@vghtpe.gov.tw