From the Guidelines
Spontaneous rupture of the carotid artery is most commonly caused by carotid artery dissection, which can occur spontaneously or be triggered by minor trauma, and is associated with underlying structural defects of the arterial wall, such as those found in connective tissue disorders like Ehlers-Danlos syndrome type IV, Marfan syndrome, and others 1. The primary causes of spontaneous carotid artery rupture can be summarized as follows:
- Carotid artery dissection, which results from an intimal tear that initiates an intramural hematoma
- Underlying structural defects of the arterial wall, including connective tissue disorders such as:
- Ehlers-Danlos syndrome type IV
- Marfan syndrome
- Autosomal dominant polycystic kidney disease
- Hyperhomocysteinemia
- Osteogenesis imperfecta
- Minor trauma, such as hyperflexion or hyperextension of the neck, chiropractic manipulation, coughing, and nose blowing The clinical presentation of cervical artery dissection is variable, but common symptoms include:
- Pain on one side of the head or neck
- Horner syndrome (asymmetrical ptosis, meiosis, and anhidrosis)
- Cerebral or retinal ischemia, which develops in 50% to 95% of cases of carotid artery dissection The diagnosis of carotid artery dissection is typically made using a combination of clinical examination, brain imaging, and vascular imaging, such as carotid duplex ultrasonography, CTA, or MRA 1. Treatment is usually conservative, involving anticoagulation with heparin followed by warfarin, and the prognosis is usually favorable, although there have been no placebo-controlled trials of anticoagulant or antiplatelet agents or randomized trials comparing anticoagulant and antiplatelet therapy 1.
From the Research
Causes of Spontaneous Rupture of the Carotid Artery
The spontaneous rupture of the carotid artery is a rare vascular disorder that can be caused by various factors, including:
- Pseudoaneurysm formation due to arterial rupture, as reported in a case study 2
- Prior irradiation and major head and neck resection, which can lead to carotid artery rupture, as seen in 11 episodes of carotid artery rupture over a 6-year period 3
- Infection, which can complicate the management of carotid artery rupture, as analyzed in a study of 46 episodes of infected carotid artery rupture 4
- Tubercular spine, which can cause unforeseen rupture of pseudoaneurysm of the common carotid artery, as reported in a rare case study 5
Predisposing Factors
Several predisposing factors can contribute to the spontaneous rupture of the carotid artery, including:
- Salivary fistula
- Local infection
- 'Herald bleed' just before major carotid artery rupture, as seen in 11 episodes of carotid artery rupture 3
- Haematological abnormalities
- Poor nutritional support
- Tissue breakdown
Management and Treatment
The management and treatment of spontaneous rupture of the carotid artery depend on the underlying cause and severity of the condition. Treatment options may include:
- Surgical exploration and repair, as performed in a case study of spontaneous rupture of the common carotid artery 2
- Endovascular techniques, such as stent placement or embolization, as used in the treatment of infected carotid artery rupture 4 and carotid blowout syndrome 6
- Surgical ligation, which may be an effective option in the management of infected carotid artery rupture, as suggested by a study of 46 episodes of infected carotid artery rupture 4