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Sun K, Zhang H, Wang C, Gong S, Pan Y, Han X, Li J, Liu K, Yu Z. Surgical Management Strategies for Carotid Artery Invasion by Head and Neck Cancer: Ligation Versus Reconstruction. Otolaryngol Head Neck Surg 2024. [PMID: 38796730 DOI: 10.1002/ohn.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/15/2024] [Accepted: 05/04/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Whether ligation or reconstruction should be performed after radical resection of the tumor and carotid artery in patients with head and neck cancers invading the carotid artery (HNC-CA) has been controversial. This paper provides a review and meta-analysis of the efficacy of these 2 modalities. DATA SOURCES PubMed, Cochrane, Web of Science, Scopus, and Ovid databases were searched through August 2023. REVIEW METHODS Descriptive, graphical, tabular, and quantitative data were extracted. The statistical outcomes (risk difference, RD) were synthesized under a random-effects model. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. RESULTS A total of 22 papers and 337 patients met the inclusion criteria for the literature review. Statistical analysis showed that the RD of overall survival (OS) rate at 1-year was 32% (95% confidence interval [CI]: 21%-42%) for ligation and 70% (95% CI: 65%-76%) for reconstruction (P < .05). The RD for OS rate at 2-year was 16% (95% CI: 7%-26%) for ligation and 39% (95% CI: 30%-47%) for reconstruction (P < .05). The RD for disease-free survival rate at 1-year was 27% (95% CI: 17%-38%) for ligation and 60% (95% CI: 51%-70%) for reconstruction (P < .05). There were no statistically significant differences (P > .05) between the 2 surgical modalities in terms of locoregional recurrence rate, carotid blowout rate, surgery-related complications rate, neurological complications rate, and perioperative mortality rate. CONCLUSION This review demonstrates the significant advantage of carotid artery reconstruction surgery in short-term patient survival, thus making it a recommended option for HNC-CA patients undergoing radical surgery.
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Affiliation(s)
- Kai Sun
- Department of Otolaryngology Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, Nanjing, Jiangsu, China
| | - Haidong Zhang
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, Nanjing, Jiangsu, China
- School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Chao Wang
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, Nanjing, Jiangsu, China
- School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Shanchun Gong
- Department of Otolaryngology Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, Nanjing, Jiangsu, China
| | - Yufei Pan
- School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Xiao Han
- Department of Otolaryngology Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, Nanjing, Jiangsu, China
| | - Jing Li
- Department of Otolaryngology Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, Nanjing, Jiangsu, China
| | - Kai Liu
- Department of Otolaryngology Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, Nanjing, Jiangsu, China
| | - Zhenkun Yu
- Department of Otolaryngology Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, Nanjing, Jiangsu, China
- School of Medicine, Southeast University, Nanjing, Jiangsu, China
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Yu KW, Wu CH, Lin TM, Tai WA, Luo CB, Chang FC. Endovascular Management of Post-Irradiated Carotid Blowout Syndrome in Patients with Lower Neck Cancers. Eur J Vasc Endovasc Surg 2024; 67:708-716. [PMID: 38182115 DOI: 10.1016/j.ejvs.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/04/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Lower neck cancers (LNCs) include specific tumour types and have some different vascular supply or collaterals from other head and neck cancers. This prospective study evaluated the outcome of endovascular management of post-irradiated carotid blowout syndrome (PCBS) in patients with LNC by comparing reconstructive management (RE) and deconstructive management (DE). METHODS This was a single centre, prospective cohort study. Patients with LNC complicated by PCBS between 2015 and 2021 were enrolled for RE or DE. RE was performed by stent graft placement covering the pathological lesion and preventive external carotid artery (ECA) embolisation without balloon test occlusion (BTO). DE was performed after successful BTO by permanent coil or adhesive agent embolisation of the internal carotid artery (ICA) and ECA to common carotid artery, or ICA occlusion alone if the pathological lesion was ICA only. Cross occlusion included the proximal and distal ends of the pathological lesion in all patients. Re-bleeding events, haemostatic period, and neurological complications were evaluated. RESULTS Fifty-nine patients (mean age 58.5 years; 56 male) were enrolled, including 28 patients undergoing RE and 31 patients undergoing DE. Three patients originally grouped to DE were transferred to RE owing to failed BTO. The results of RE vs. DE were as follows: rebleeding events, 13/28 (46%) vs. 10/31 (32%) (p = .27); haemostatic period, 9.4 ± 14.0 months vs. 14.2 ± 27.8 months (p = .59); neurological complication, 4/28 (14%) vs. 5/31 (16%) (p = .84); and survival time, 11.8 ± 14.6 months vs. 15.1 ± 27.5 months (p = .61). CONCLUSION No difference in rebleeding risk or neurological complications was observed between the DE and RE groups. RE could be used as a potential routine treatment for PCBS in patients with LNC.
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Affiliation(s)
- Kai-Wei Yu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Te-Ming Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-An Tai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Brenner DA, Valdivia DJ, Ginalis EE, Dadario NB, Mashiach E, Gupta G, Sundararajan S, Nourollah-Zadeh E, Lazar E, Roychowdhury S, Sun H. Brain abscesses following carotid blowout syndrome: a case report. Radiol Case Rep 2024; 19:1319-1324. [PMID: 38292792 PMCID: PMC10825556 DOI: 10.1016/j.radcr.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 02/01/2024] Open
Abstract
We report a case of intracranial abscesses development in a patient with head and neck cancer after emergent treatment of carotid blowout syndrome with coil embolization. Our patient is a 60-year-old male who presented with hemoptysis and hematemesis, which raised concerns for impending carotid blowout syndrome. Endovascular occlusion was successfully achieved, and the patient was discharged in stable condition. Ten days later, the patient reported headaches and right facial pain, and magnetic resonance imaging revealed multiple intracranial abscesses. Broad-spectrum intravenous antibiotics were administered, leading to a variable response with some abscesses decreasing in size and others increasing. Seven weeks from discharge, the patient had no neurological deficits, and all abscesses had decreased in size.
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Affiliation(s)
- Daniel A. Brenner
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Daniel J. Valdivia
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | | | - Nicholas B. Dadario
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Elad Mashiach
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Srihari Sundararajan
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Emad Nourollah-Zadeh
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Eric Lazar
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hai Sun
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
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Gao K, Guo W, Shang Y, Liu G, Zhai X, Li H, Shi M, Tong X. Surgical treatment of carotid blowout syndrome after radiotherapy for head and neck malignant tumors: a single-center experience. Neurosurg Rev 2023; 46:293. [PMID: 37924361 DOI: 10.1007/s10143-023-02193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
To explore the treatments for and manifestations of carotid blowout syndrome (CBS) and to further explore the critical role of high-flow bypass combined with parent artery isolation. The clinical data of nine patients with radiotherapy-related CBS who were admitted to our hospital from March 2020 to March 2023 were retrospectively analyzed. Relevant literature was reviewed. From March 2020 to March 2023, nine CBS patients were admitted to Tianjin Huanhu Hospital, including eight males and one female. Digital subtraction angiography was performed for all the patients; all the pseudoaneurysms were located at the petrous segment of the internal carotid artery. A balloon occlusion test was performed on four patients, which was tolerated by all patients. CT and MRI scans showed seven cases of osteonecrosis combined with infection and two cases of tumor recurrence. Emergency permanent parent artery occlusion was performed on six patients, aneurysm embolization was completed in one case, covered stent implantation was performed in one patient, and three cases were treated by cerebral bypass surgery (including two patients with failed interventional treatment). Rebleeding was found in two patients, and no rebleeding was found in the bypass group. Paralysis was found in three patients, and asymptomatic cerebral infarction without permanent neurologic impairment was found in three patients. Two patients died due to tumor progression. Emergency occlusion surgery is lifesaving in the acute phase of CBS. Endovascular therapy cannot prevent the progression of pseudoaneurysms or lower the recurrence rate of bleeding events. High-flow bypass combined with parent artery isolation is a safe and effective method that may facilitate further surgical treatment. Further research is warranted.
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Affiliation(s)
- Kaiming Gao
- Department of Neurosurgery, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Wenqiang Guo
- Department of Neurosurgery, Qilu Hospital of Shandong University (Qingdao), 758 Hefei Road, Shibei District, Qingdao, Shandong, 266035, China
| | - Yanguo Shang
- Department of Neurosurgery, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Gang Liu
- Department of Otorhinolaryngology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Otorhinolaryngology, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Xiang Zhai
- Department of Otorhinolaryngology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Otorhinolaryngology, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Haiyan Li
- Department of Otorhinolaryngology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Otorhinolaryngology, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Minggang Shi
- Department of Neurosurgery, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China.
| | - Xiaoguang Tong
- Department of Neurosurgery, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China.
- Laboratory of Microneurosurgery, Tianjin Neurosurgical Institute, Tianjin, China.
- Tianjin Key Laboratory of Cerebral Vascular and Neural Degenerative Diseases, Tianjin, China.
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Slijepcevic AA, Roh J, Pipkorn P, Lipsey K, Bradley JP. Carotid Blowout Syndrome in Head and Neck Cancer Patients: Management of Patients At Risk for CBS. Laryngoscope 2023; 133:576-587. [PMID: 35575599 DOI: 10.1002/lary.30157] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Carotid blowout syndrome (CBS) is an acute, rare life-threatening hemorrhage that occurs in patients with a history of head and neck cancer and radiation therapy. The primary objective of this review was to identify risk factors and assess treatment and survival outcomes following CBS. METHODS A systematic review of published literature was performed. Information including risk factors, treatment, and outcomes of CBS were collected. RESULTS A total of 49 articles and 2220 patients were included in the systematic review. Risk factors for developing CBS included a history of radiation therapy, wound complications, and advanced tumor stage. The initial management of CBS included establishing a stable airway, gaining hemostasis, and repletion of blood loss. Endovascular and surgical procedures treat CBS with infrequent rates of rebleeding and periprocedural complications. Short-term survival following treatment of CBS shows high survival rates when considering CBS-related complications and underlying disease, however, long-term survival related to the underlying disease demonstrated high mortality. CONCLUSIONS Identifying patients at risk for CBS enables practitioners to counsel patients on life-saving interventions and expected outcomes following treatment of CBS. Treatment of CBS is associated with high short-term survival, although long-term survival related to underlying disease is low. LEVEL OF EVIDENCE N/A Laryngoscope, 133:576-587, 2023.
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Affiliation(s)
- Allison A Slijepcevic
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joseph Roh
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kim Lipsey
- Bernard Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Joseph P Bradley
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Cocca AT, Levy BE, Castle JT, Wilt WS, Fleming MD, Kejner AE, Aouad RK, Tyagi SC. Management of Double Carotid Blow Out with Definitive Repair After Temporizing Stent Graft Placement. J Vasc Surg Cases Innov Tech 2022; 8:606-609. [PMID: 36248383 PMCID: PMC9556593 DOI: 10.1016/j.jvscit.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Carotid blowout syndrome is a life-threatening complication for patients with head and neck cancer. Temporizing stent graft procedures improve short-term survival and can be the definitive treatment for various reasons, including a poor oncologic prognosis, unsuitability for definitive reconstruction, or a lack of operative options. A second carotid blowout will often be fatal. Preventing such events requires multidisciplinary strategic planning because of a hostile reoperative field. We have described a case of a 44-year-old man with a history of laryngeal cancer who had experienced a carotid blowout. Treated with a stent graft, the patient had experienced a second event 6 weeks later. Treatment involved excision and suture ligation with rotational muscle flap coverage.
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Harrington CÍ, O'Keeffe N, Lennon P. Recurrent Carotid artery blow out in a head & neck patient. Int J Surg Case Rep 2022; 94:107089. [PMID: 35658281 PMCID: PMC9065702 DOI: 10.1016/j.ijscr.2022.107089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Carotid artery blowout syndrome is a rare complication of head and neck cancer treatment. It defines a rupture of the carotid artery wall through vessel wall necrosis. This is typically precipitated by radiotherapy, direct tumour invasion, or a combination of these factors. We describe a rare case of three consecutive carotid artery blowouts in a head and neck cancer patient. Case presentation A 58-year-old man with a history of T3NO hypopharyngeal squamous cell carcinoma (SCC) treated with chemotherapy and radiation presented with a four-month history of progressive dysphagia and right sided neck pain. Flexible nasendoscopy revealed laryngeal oedema and slough. A panendoscopy and biopsy showed no evidence of tumour recurrence. The patient was discharged and represented with worsening dyspnoea. He subsequently experienced a large volume hemorrhage necessitating ligation of his right external carotid artery. He underwent pharyngolaryngectomy indicated due to the extent of laryngeal radiation necrosis. Thereafter he suffered two additional acute carotid bleeds from his right common carotid necessitating ligation in theatre. Clinical discussion and conclusion This case report illustrates the key issues to be considered in patients with locally advanced hypopharyngeal squamous cell carcinoma and subsequent management of acute carotid blowout syndrome, which without prompt management, can be fatal. Carotid artery rupture, or blowout, has a high morbidity and mortality. Carotid blowout is a rare consequence of head and neck cancer treatment. Radiotherapy is the main predisposing risk factor. Acute carotid blowout requires prompt resuscitation and bleeding source control. Definitive treatment includes endovascular occlusion, stenting or surgical ligation.
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Affiliation(s)
- Cara Íosa Harrington
- Department of Otolaryngology/Head & Neck Surgery, St James' Hospital, Dublin 8, Ireland.
| | - Nicholas O'Keeffe
- Department of Otolaryngology/Head & Neck Surgery, St James' Hospital, Dublin 8, Ireland
| | - Paul Lennon
- Department of Otolaryngology/Head & Neck Surgery, St James' Hospital, Dublin 8, Ireland
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Kolu M, Yıldırım İO. Treatment of a patient with carotid blowout syndrome with a new deconstructive embolization technique. Radiol Case Rep 2021; 17:310-313. [PMID: 34876956 PMCID: PMC8633831 DOI: 10.1016/j.radcr.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 11/07/2022] Open
Abstract
Carotid blowout syndrome is a rare clinical conditions with a high mortality rate, especially in patients with head and neck tumors who have received radiotherapy and chemotherapy. We present our patient who had hemangioendothelioma of the neck for 5 years and therefore received radiotherapy, fistulized to the skin on the neck and active bleeding out of the fistula area. In the radiological imaging of the patient, vessel wall irregularities in the common carotid artery (CCA) and accompanying pseudoaneurysm with a diameter of 3 cm were detected, and endovascular treatment was performed. After the patient passed the balloon occlusion test, first the proximal internal carotid artery was closed with coils. Then, the balloon was inflated proximal to the CCA and a 10% diluted glue-lipiodol mixture was injected into the entire diseased CCA bed. Closure of the distal with coil and proximal with balloon prevented the risk of off-target embolization of the glue.
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Affiliation(s)
- Mehmet Kolu
- Dicle University, Faculty of Medicine, Department of Radiology, Diyarbakır, Turkey
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Eguchi K, Kobayashi K, Takano T, Ito A, Sakai A, Ikeda A, Matsumoto Y, Omura G, Matsumoto F, Yoshimoto S. Carotid artery ligation via sternotomy as a palliative surgery: Case report of advanced intramediastinal malignant soft tissue tumor. Clin Case Rep 2021; 9:CCR33979. [PMID: 34466234 PMCID: PMC8385775 DOI: 10.1002/ccr3.3979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/08/2021] [Indexed: 11/22/2022] Open
Abstract
Under extreme conditions and in palliative settings, shared decision making with the patient is vital; narrative decisions beyond evidence could be considered. If there is a chance of symptom palliation, extended surgery should not be avoided merely because of the limited life expectancy.
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Affiliation(s)
- Kohtaro Eguchi
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Kenya Kobayashi
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Tomonari Takano
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Akiko Ito
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Azusa Sakai
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Atsuo Ikeda
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Yoshifumi Matsumoto
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Go Omura
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Fumihiko Matsumoto
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
| | - Seiichi Yoshimoto
- Department of Head and Neck SurgeryNational Cancer Center HospitalTokyoJapan
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Wu PA, Yuan GY, Zhou RM, Ho WWS, Lu ZQ, Cai JF, Yang SY, Tsang RKY, Chan JYW. Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer - Related Carotid Blowout Syndrome. Laryngoscope 2021; 131:1548-1556. [PMID: 33571390 DOI: 10.1002/lary.29427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/01/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE/HYPOTHESIS To investigate the endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass in the management of patients with head and neck cancer-related carotid blowout syndrome (CBS). STUDY DESIGN Retrospective case series. METHODS Retrospective analysis of clinical data of patients with head and neck cancer-related CBS treated by endovascular intervention and/or EC/IC vascular bypass, analysis of its bleeding control, neurological complications, and survival results. RESULTS Thrity-seven patients were included. Twenty-five were associated with external carotid artery (ECA); twelve were associated with internal or common carotid artery (ICA/CCA). All patients with ECA hemorrhage were treated with endovascular embolization. Of the 12 patients with ICA/CCA hemorrhage, 9 underwent EC/IC bypass, 1 underwent endovascular embolization, and 3 underwent endovascular stenting. For patients with ECA-related CBS, the median survival was 6 months, and the 90-day, 1-year, and 2-year survival rates were 67.1%, 44.7%, and 33.6%, respectively; the estimated rebleeding risk at 1-month, 6-month, and 2-year was 7.1%, 20.0%, and 31.6%, respectively. For patients with ICA/CCA-related CBS, the median survival was 22.5 months, and the 90-day, 1-year, and 2-year survival rates were 92.3%, 71.8%, and 41.0%, respectively; the estimated rebleeding risk at 1 month, 6 months, and 2 years is 7.7%,15.4%, and 15.4%, respectively. ICA/CCA-related CBS patients have significantly longer survival time and lower risk of rebleeding, which may be related to the more use of EC/IC vascular bypass as a definite treatment. CONCLUSIONS For patients with ICA/CCA-related CBS, if there is more stable hemodynamics, longer expected survival, EC/IC vascular bypass is preferred. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1548-1556, 2021.
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Affiliation(s)
- Ping-An Wu
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Guo-Yan Yuan
- Department of Surgery, Division of Neurosurgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Ru-Ming Zhou
- Department of Interventional Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Wilson Wai-Shing Ho
- Department of Surgery, Division of Neurosurgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Zhao-Qun Lu
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Ji-Fu Cai
- Department of Neurology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Si-Yi Yang
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Raymond King-Yin Tsang
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
| | - Jimmy Yu-Wai Chan
- Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China
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11
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Sánchez-Canteli M, Rodrigo JP, Quintana EM, Vega P, Llorente JL, López F. Embolization for Carotid Blowout in Head and Neck Cancer: Case Report of Five Patients. Vasc Endovascular Surg 2021; 56:53-57. [PMID: 34155944 DOI: 10.1177/15385744211027030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid blowout syndrome (CBS) is defined as a rupture of common carotid artery or its branches. Endovascular intervention has been advocated as first line of treatment for CBS. This Case Report describes 5 patients with prior history of head and neck cancer who presented with CBS. Two patients presented as acute, 2 as impending, and one as threatened CBS. The lesions found were pseudoaneurysm and focal vascular irregularities involving the common carotid artery, cervical internal carotid artery and lingual artery. Embolization and occlusion with detachable coils of the artery was used in all patients. Technical success and immediate hemostasis were achieved in all patients. One patient presented transient cranial nerve palsy. No recurrent CBS was reported during the follow-up. In our experience, coil embolization, if possible, is a safe and efficient technique in treatment of CBS secondary to head and neck cancers.
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Affiliation(s)
- Mario Sánchez-Canteli
- Department of Otolaryngology, 16474Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, 16474Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Universidad de Oviedo, Spain
| | - Eduardo Murias Quintana
- Department of Radiology-Interventional Neuroradiology, 16474Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pedro Vega
- Department of Radiology-Interventional Neuroradiology, 16474Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Luis Llorente
- Department of Otolaryngology, 16474Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Universidad de Oviedo, Spain
| | - Fernando López
- Department of Otolaryngology, 16474Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Universidad de Oviedo, Spain
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12
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Chatani S, Sato Y, Murata S, Hasegawa T, Tsukii R, Nagasawa K, Machida M, Yoshihara T, Yamaura H, Hanai N, Matsuo K, Inaba Y. Transarterial Embolization for Bleeding in Patients with Head and Neck Cancer: Who Benefits? Laryngoscope 2021; 131:E2777-E2783. [PMID: 33960405 DOI: 10.1002/lary.29611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/07/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES/HYPOTHESIS The present study aimed to investigate the efficacy of transarterial embolization (TAE) for bleeding in patients with head and neck cancer (HNC) and to evaluate the prognostic factors after TAE. STUDY DESIGN Outcome study. METHODS This retrospective study included 31 consecutive patients (27 men and 4 women; median age, 61 years) who presented uncontrollable hemorrhage associated with HNC and underwent emergency TAE at our institution during a 10-year period (January 2011-December 2020). This corresponded to 40 TAE procedures, including 27 cases with an unstable status (circulatory and/or respiratory insufficiency) and 10 cases with carotid blowout syndrome. The technical success rate and adverse events were analyzed on a per-procedure basis. The rebleeding and overall survival (OS) rates were analyzed on a per-patient basis, and the factors related to OS were evaluated. RESULTS The technical success rate was 100%. As an adverse event, cerebral infarction was found in three cases with carotid blowout syndrome. The rebleeding rate at 30 days after TAE and in the follow-up period (range, 9-3,004 days) was 17.2% and 35.5%, respectively. The median survival time was 263 days (95% confidence interval: 124.0-402.0 days). In the log-rank test, complete remission (CR) of the primary cancer at the time of the first TAE was identified as a significant influencing factor of survival. CONCLUSION TAE is effective for the treatment of hemorrhage associated with HNC even in patients with an unstable status. Patients with CR can gain a long life span. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2021.
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Affiliation(s)
- Shohei Chatani
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.,Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Ryota Tsukii
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Kyohei Nagasawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Masanori Machida
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Terutaka Yoshihara
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Hidekazu Yamaura
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
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13
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Ota N, Valenzuela JC, Chida D, Tanikawa R. Extracranial vertebral artery to middle cerebral artery bypass in therapeutic internal carotid artery occlusion for epipharyngeal carcinoma: A technical case report. Surg Neurol Int 2021; 12:149. [PMID: 33948319 PMCID: PMC8088539 DOI: 10.25259/sni_99_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/06/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Vertebral artery (VA) to middle cerebral artery (MCA) bypass is a rarely selected technique because a complex expanded dissection is required, and often, a better donor artery than VA exists. A good indication for VA-MCA bypass is the treatment of head-and-neck malignancies with the sacrifice of the internal carotid artery (ICA) or for carotid artery rupture. Methods: A 23-year-old man with epipharyngeal carcinoma, treated by ligating the carotid artery with a VAMCA bypass before chemoradiotherapy, was reported. Radiographic findings showed that the bone of the carotid canal was dissolved, and the right ICA was engulfed by the tumor. As epipharyngeal carcinoma is hypersensitive to radiation, in cases where the tumor rapidly disappears, ICA may dangle in the pharynx and rupture may occur. In addition, to irradiate sufficiently, the ICA may become an obstacle. Hence, we decided to perform carotid ligation with a VA-MCA bypass before radiation and chemotherapy for the primary lesion. We selected the V3 portion of the VA as the donor on the ipsilateral side, as it can supply high-flow cerebral blood flow, which is not influenced by carcinoma and less influenced by irradiation for the epipharynx. Results: The VA-MCA bypass was completed without complications followed by endovascular occlusion of the ICA. Induction chemotherapy was initiated for the patient 2 weeks after surgery. The patient achieved a complete response following chemoradiotherapy. Conclusion: ICA ligation with VA-MCA high-flow bypass earlier than chemoradiotherapy is useful for epipharyngeal carcinoma as it prevents carotid artery rupture and allows radical intervention.
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Affiliation(s)
- Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Japan
| | | | - Daiki Chida
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Japan
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14
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Wang G, Li C, Piao J, Xu B, Yu J. Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma. Int J Med Sci 2021; 18:944-952. [PMID: 33456352 PMCID: PMC7807178 DOI: 10.7150/ijms.50275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/18/2020] [Indexed: 11/15/2022] Open
Abstract
The extracranial internal carotid artery (ICA) refers to the anatomic location that reaches from the common carotid artery proximally to the skull base distally. The extracranial ICA belongs to the C1 segment of the Bouthillier classification and is at considerable risk for injury. Currently, the understanding of endovascular treatment (EVT) for blunt injury of the extracranial ICA is limited, and a comprehensive review is therefore important. In this review, we found that extracranial ICA blunt injury should be identified in patients presenting after blunt trauma, including classical dissection, pseudoaneurysm, and stenosis/occlusion. Computed tomography angiography (CTA) is the first-line method for screening for extracranial ICA blunt injury, although digital subtraction angiography (DSA) remains the "gold standard" in imaging. Antithrombotic treatment is effective for stroke prevention. However, routine EVT in the form of stenting should be reserved for patients with prolonged neurological symptoms from arterial stenosis or considerably enlarged pseudoaneurysm. Endovascular repair is now emerging as a favored therapeutic option given its demonstrated safety and positive clinical and radiographic outcomes.
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Affiliation(s)
- Guangming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Chao Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jianmin Piao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
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15
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Carotid Blowout Management in the Endovascular Era. World Neurosurg 2020; 141:e1010-e1016. [PMID: 32599207 DOI: 10.1016/j.wneu.2020.06.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is a potential complication of head and neck cancer, and its therapy is associated with high morbidity and mortality. Recent advances in endovascular techniques have improved patient outcomes. In this study, we report outcomes of emergent endovascular intervention for CBS. METHODS We conducted a retrospective analysis of a prospectively maintained neurovascular database and identified 38 consecutive endovascular procedures for CBS from 2008-2019 at our institution. Data collection was performed on patient demographics, type of cancer, previous cancer treatments, type of CBS, location of bleed, diagnostic workup, endovascular treatment, and procedural outcomes and complications. RESULTS A total of 38 consecutive endovascular procedures for CBS were performed from 2008-2019 at our single academic institution. Technical success was achieved in 100% of endovascular procedures. Procedural stroke occurred in 1 (2.6%) procedure, procedural mortality occurred in 1 (2.6%) procedure, recurrent CBS occurred in 4 (10.5%) procedures, and fatal rehemorrhage occurred in 1 (2.6%) procedure. Regarding secondary outcomes, delayed stroke/transient ischemic attack occurred in 1 (2.6%) procedure, whereas there were no cases of delayed infectious complications. CONCLUSIONS The endovascular treatment of CBS is safe and effective with relatively low rates of morbidity and mortality compared with other currently available treatment modalities. However, the overall rate of complications demands attention and sheds light on the need for further improvement in management.
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16
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Matsumoto F, Matsumura S, Mori T, Mori A, Omura G, Matsumoto Y, Fukasawa M, Kobayashi K, Yoshimoto S. Common carotid artery ligation at the proximal side before rupture in patients with ligation or occlusion of the external carotid artery at risk of carotid blowout syndrome. Jpn J Clin Oncol 2019; 49:839-844. [PMID: 31135919 DOI: 10.1093/jjco/hyz075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/26/2019] [Accepted: 05/11/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is among the fatal complications in head and neck cancer treatment. However, the optimal treatment for CBS has not been established yet. This study aimed to describe our experience with two patients at high risk of CBS who underwent common carotid artery (CCA) ligation at the proximal side of the bleeding point under local anesthesia and before CCA rupture, and to review and compare the medical records of these two patients against 10 CBS cases treated in our department. METHODS The institutional electronic medical record was searched, and clinical information was extracted for all patients who showed CBS from 2007 to 2017. Our treatment method was performed as follows. Ligation of the proximal side of the CCA was performed under local anesthesia. The CCA was identified and clamped with two bulldog forceps for 10 minutes to check for any adverse neurological symptoms. Subsequently, the CCA was ligated using 2-0 silk threads and sutured with an absorbable suture between the silk threads. However, ligation or occlusion of the external carotid artery by previous treatment is a prerequisite for this method. RESULTS Eight patients received interventions, with six patients undergoing prophylactic interventions before rupture. Four patients who did not undergo treatment died owing to CBS. Two patients who underwent treatment with the novel method did not experience re-bleeding, but their conditions deteriorated owing to cancer progression. CONCLUSION The present method is one of the treatment choices for CBS, especially in patients with an 'impending' risk of CBS.
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Affiliation(s)
- Fumihiko Matsumoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoko Matsumura
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - Ayaka Mori
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Go Omura
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshifumi Matsumoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Fukasawa
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenya Kobayashi
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Oncology, National Cancer Center Hospital, Tokyo, Japan
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17
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Durmaz H, Ergun O, Birgi E, Bayir Ö, Saylam G. Endovascular management of the carotid blowout syndrome: a single-center experience. Eur Arch Otorhinolaryngol 2019; 276:2881-2886. [DOI: 10.1007/s00405-019-05548-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022]
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18
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Emergency high-flow bypass for the management of ruptured postirradiated internal carotid artery pseudoaneurysms in nasopharyngeal carcinoma patients. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Suárez C, Fernández-Alvarez V, Hamoir M, Mendenhall WM, Strojan P, Quer M, Silver CE, Rodrigo JP, Rinaldo A, Ferlito A. Carotid blowout syndrome: modern trends in management. Cancer Manag Res 2018; 10:5617-5628. [PMID: 30519108 PMCID: PMC6239123 DOI: 10.2147/cmar.s180164] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Carotid blowout syndrome (CBS) refers to rupture of the carotid artery and is an uncommon complication of head and neck cancer that can be rapidly fatal without prompt diagnosis and intervention. CBS develops when a damaged arterial wall cannot sustain its integrity against the patient’s blood pressure, mainly in patients who have undergone surgical procedures and radiotherapy due to cancer of the head and neck, or have been reirradiated for a recurrent or second primary tumor in the neck. Among patients irradiated prior to surgery, CBS is usually a result of wound breakdown, pharyngocutaneous fistula and infection. This complication has often been fatal in the past, but at the present time, early diagnosis and modern technology applied to its management have decreased morbidity and mortality rates. In addition to analysis of the causes and consequences of CBS, the purpose of this paper is to critically review methods for early diagnosis of this complication and establish individualized treatment based on endovascular procedures for each patient.
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Affiliation(s)
- Carlos Suárez
- Head & Neck Cancer Laboratory, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain, .,Head & Neck Cancer Laboratory, Instituto Universitario de Oncología del Principado de Asturias, CIBERONC, University of Oviedo, Oviedo, Spain,
| | | | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, King Albert II Cancer Institute, St Luc University Hospital, Brussels, Belgium
| | | | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona, Phoenix, AZ, USA
| | - Juan P Rodrigo
- Head & Neck Cancer Laboratory, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain, .,Head & Neck Cancer Laboratory, Instituto Universitario de Oncología del Principado de Asturias, CIBERONC, University of Oviedo, Oviedo, Spain, .,Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group Padua, Italy
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20
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Successful Use of Covered Stent for Carotid Artery Injury with Active Medial Projecting Extravasation. World Neurosurg 2018; 112:53-56. [DOI: 10.1016/j.wneu.2018.01.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/13/2022]
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21
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Wong DJY, Donaldson C, Lai LT, Coleman A, Giddings C, Slater LA, Chandra RV. Safety and effectiveness of endovascular embolization or stent-graft reconstruction for treatment of acute carotid blowout syndrome in patients with head and neck cancer: Case series and systematic review of observational studies. Head Neck 2017; 40:846-854. [PMID: 29155470 DOI: 10.1002/hed.25018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 08/23/2017] [Accepted: 10/10/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Indications for treatment and outcomes after endovascular management of carotid blowout syndrome for patients with head and neck cancer are not well defined. We investigated the safety and effectiveness of endovascular embolization and stent-graft reconstruction. METHODS A literature review was performed for studies published between 2001 and 2015 with relevance to treatment outcomes. Our institutional database was examined to identify patients treated with endovascular techniques. RESULTS A total of 266 patients were included. Rates of procedural stroke were higher after embolization of internal carotid artery (ICA)/common carotid artery (CCA) compared to stent graft (embolization 10.3%; stent graft 2.5%; P < .02). Stent graft of ICA/CCA was associated with higher rates of recurrent bleeding (embolization 9.1%; stent graft 31.9%; P < .01). CONCLUSION Both embolization and stent grafts are safe therapeutic options for acute carotid blowout syndrome. Embolization for ICA/CCA carotid blowout syndrome was associated with higher risks of procedural stroke and lower recurrent bleeding compared to stent grafts.
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Affiliation(s)
- Daniel J Y Wong
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia
| | | | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | | | - Charles Giddings
- Department of Otolaryngology, Monash Health, Melbourne, Australia
| | - Lee-Anne Slater
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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22
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Oishi K, Takabatake D, Shibuya Y. Efficacy of lenvatinib in a patient with anaplastic thyroid cancer. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM160136. [PMID: 28620501 PMCID: PMC5467670 DOI: 10.1530/edm-16-0136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/04/2017] [Indexed: 11/08/2022] Open
Abstract
We experienced a case of an 82-year-old woman who presented to our hospital with a 1-month history of dysphagia and dyspnea. Cervical contrast-enhanced computed tomography revealed diffuse thyroid neoplasms causing significant tracheal stenosis with tumors, particularly of the superior mediastinum, which were associated with an embolism of the brachiocephalic vein and suspected invasion to the bilateral common carotid arteries. Anaplastic thyroid cancer (ATC) was diagnosed by fine-needle aspiration; thus, emergency tracheostomy and gastrostomy were performed. We made a definitive diagnosis of ATC (T4bN0M0 Stage IVB) and initiated continuous lenvatinib administration at 24 mg/day. Although several adverse events occurred, the tumor size reduced remarkably over a short period. However, the patient died from rupture of the common carotid artery 30 days after treatment initiation. Here, we report our experience with lenvatinib therapy for ATC and include a literature review. LEARNING POINTS Lenvatinib is extremely effective for ATC.Lenvatinib has a much greater cytoreductive effect than traditional therapies, but it needs dose reduction or withdrawal because of treatment-related side effects.Lenvatinib may cause treatment-related carotid blowout syndrome, resulting in death for patients with invasion to the carotid artery.
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Affiliation(s)
- Kazuyuki Oishi
- Kochi Health Sciences Center - Divisions of Breast & Thyroid SurgeryKochi, Japan
| | - Daisuke Takabatake
- Kochi Health Sciences Center - Divisions of Breast & Thyroid SurgeryKochi, Japan
| | - Yuichi Shibuya
- Kochi Health Sciences Center - Divisions of Breast & Thyroid SurgeryKochi, Japan
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23
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Bond KM, Brinjikji W, Murad MH, Cloft HJ, Lanzino G. Endovascular treatment of carotid blowout syndrome. J Vasc Surg 2017; 65:883-888. [PMID: 28236928 DOI: 10.1016/j.jvs.2016.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is a life-threatening complication of head and neck cancer and radiation therapy. Endovascular techniques have emerged as preferable alternatives to surgical ligation for treatment of CBS. We performed a systematic review and meta-analysis to study periprocedural complications and outcomes of CBS patients treated with coil embolization and covered stents. METHODS A comprehensive literature search identified studies that reported outcomes of endovascular treatment of CBS published from 2000 to April 2016. Outcomes included technical success, postoperative rebleeding, survival time, and perioperative complications. Meta-analyses were performed using a random-effects model. RESULTS Twenty-five noncomparative studies with 559 patients were included in the meta-analysis. Technical success rate was 100% in both coiling and covered stenting groups. Median survival time was 3 months (range, 0-96 months) for all CBS patients. Overall perioperative mortality was 11% (95% confidence interval [CI], 5%-17%). Postoperative rebleeding rate was 27% (95% CI, 19%-367%). Perioperative stroke and infection rates were 3% (95% CI, 1%-6%) and 1% (95% CI, 0%-5%), respectively. At last follow-up, 39% of patients were alive (95% CI, 29%-48%). CONCLUSIONS Coil embolization and stent grafts may both be safe treatment options for CBS with few perioperative complications and high rates of technical success, but prognosis after treatment remains poor. In general, noncomparative studies do not demonstrate differences between the two techniques with respect to periprocedural complications and patient outcomes.
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Affiliation(s)
| | | | - Mohammed H Murad
- Department of Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minn
| | - Giuseppe Lanzino
- Department of Radiology, Mayo Clinic, Rochester, Minn; Department of Neurosurgery, Mayo Clinic, Rochester, Minn
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24
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Manzoor NF, Rezaee RP, Ray A, Wick CC, Blackham K, Stepnick D, Lavertu P, Zender CA. Contemporary management of carotid blowout syndrome utilizing endovascular techniques. Laryngoscope 2016; 127:383-390. [PMID: 27900766 DOI: 10.1002/lary.26144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS). STUDY DESIGNS Retrospective chart review. METHODS Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied. RESULTS Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable. CONCLUSIONS The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist. LEVEL OF EVIDENCE 4. Laryngoscope, 2016 127:383-390, 2017.
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Affiliation(s)
- Nauman F Manzoor
- Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Rod P Rezaee
- Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Abhishek Ray
- Department of Neuroradiology, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Cameron C Wick
- Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Kristine Blackham
- Department of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | - David Stepnick
- Department of Otolaryngology, Metro Health Medical Center, Cleveland, Ohio, U.S.A
| | - Pierre Lavertu
- Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
| | - Chad A Zender
- Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A
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25
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Brinjikji W, Cloft HJ. Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout. Interv Neuroradiol 2015; 21:543-7. [PMID: 26089247 DOI: 10.1177/1591019915590078] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Carotid blowout is a life threatening complication of invasive head and neck cancers and their treatments. This is commonly treated with endovascular embolization and carotid stenting. Using the Nationwide Inpatient Sample, we report the immediate clinical results of patients receiving embolization and/or stenting for treatment of carotid blowout associated with head and neck cancer. MATERIALS AND METHODS Using the Nationwide Inpatient Sample from the period 2003-2011, we defined carotid blowout patients as those with head and neck malignancies receiving carotid stenting and/or endovascular embolization without open surgery. Outcomes studied included mortality, acute ischemic stroke, hemiplegia/paresis, and other post-operative neurologic complications. Outcomes for the endovascular embolization and carotid stenting group were compared. RESULTS A total of 1218 patients underwent endovascular treatment for carotid blowout. Of these, 1080 patients (88.6%) underwent embolization procedures and 138 patients (11.4%) underwent carotid stenting. The mortality rate of endovascular embolization patients was similar to that of carotid stenting patients (8.0%, 95% confidence interval (CI) = 6.5%-9.7% versus 10.2%, 95% CI=6.0%-16.4%, p = 0.36). Stroke rate was similar between embolization patients and stenting patients (2.3%, 95% CI=1.6%-3.4% vs. 3.4%, 95% CI=1.3%-8.4%, p = 0.43). Hemiplegia rates were significantly higher rate in stenting patients compared with endovascular occlusion patients (3.8%, 95% CI=1.3%-8.4% vs. 1.4%, 95% CI=1.4%-2.4%, p = 0.05). The rate of post-operative neurologic complications was higher in stenting patients compared with embolization patients (6.5%, 95% CI=3.3%-12.1% vs. 1.4%, 95% CI=0.9%-2.4%, p < 0.0001). CONCLUSIONS Given the natural history of carotid blowout, carotid stenting and endovascular embolization are acceptable means of treating this disease. Endovascular embolization remains the most common treatment among patients with head and neck cancers with lower overall rates of post-operative neurologic complications, including hemiplegia/paresis and stroke.
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Affiliation(s)
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, USA
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Haas RA, Ahn SH. Interventional management of head and neck emergencies: carotid blowout. Semin Intervent Radiol 2014; 30:245-8. [PMID: 24436546 DOI: 10.1055/s-0033-1353477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Involvement of the carotid artery by malignant processes of the head and neck with compromise of vessel integrity and rupture-"carotid blowout syndrome" (CBS)-is one of the most devastating complications of malignancy. Most often, it is associated with squamous cell cancer and almost always in patients who have undergone prior radiation therapy. CBS is classified as threatened, impending, or acute. Bleeding into the oral cavity or from areas of skin breakdown is a frightening experience for patients and their families and often a terminal event. Prognosis is poor with up to 50% mortality and morbidity, and surgical options are limited and risky. Endovascular management with vessel sacrifice or stent placement has become the principle treatment option in this patient population, though still associated with procedural complications, often neurologic, that can occur acutely or in a delayed fashion. This article reviews techniques and outcomes associated with endovascular treatment of CBS.
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Affiliation(s)
- Richard A Haas
- Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Sun Ho Ahn
- Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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Liu J, Zeng Q, Huang JJ, Hu GH. Management of infected carotid artery rupture. Eur Arch Otorhinolaryngol 2013; 271:1723-8. [DOI: 10.1007/s00405-013-2678-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/20/2013] [Indexed: 12/15/2022]
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Patel SN, Sauvageau E, Padhya TA. Rare treatment of radiation induced carotid pseudoaneurysm and ensuing carotid blowout syndrome with placement of multiple contiguous endovascular stents: a case report. Am J Otolaryngol 2013; 34:219-22. [PMID: 23332404 DOI: 10.1016/j.amjoto.2012.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/06/2012] [Indexed: 11/17/2022]
Abstract
Cervical radiotherapy for treatment of head and neck cancer can result in the delayed carotid vasculopathy. Surgical management for an ensuing hemorrhage is challenging due to the associated high mortality and morbidity. We present a case of a relative rapid formation of common carotid pseudoaneurysm formation with subsequent carotid blowout syndrome in previously irradiated neck. Successful treatment in our patient is highlighted by the fact that multiple, contiguous endovascular stents were placed emergently to obtain control of pseudoaneurysm rupture.
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Affiliation(s)
- Samip N Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada.
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Shah H, Gemmete JJ, Chaudhary N, Pandey AS, Ansari SA. Acute life-threatening hemorrhage in patients with head and neck cancer presenting with carotid blowout syndrome: follow-up results after initial hemostasis with covered-stent placement. AJNR Am J Neuroradiol 2011; 32:743-7. [PMID: 21436338 DOI: 10.3174/ajnr.a2379] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE CSP in patients with HNC presenting with CBS can provide immediate hemostasis to prevent exsanguination. We evaluated the safety and efficacy of CSP to control acute life-threatening hemorrhage in patients with HNC presenting with CBS. MATERIALS AND METHODS We retrospectively reviewed 10 patients (7 men, 3 women; mean age, 59 years) with HNC presenting with acute life-threatening hemorrhage from CBS that was treated with CSP. We studied patient demographics, presentations, procedures, initial and delayed complications, and technical and clinical outcomes on follow-up. RESULTS All patients achieved immediate hemostasis following CSP. Periprocedural complications consisted of groin hematomas (n=2), acute limb ischemia requiring thrombectomy, and an asymptomatic temporal lobe hemorrhage. Imaging and clinical follow-up were available for a mean of 17.7 months (range, 1-60 months). Two patients remained asymptomatic with a patent stent and no evidence of rebleeding at 17 and 21 months, respectively. Recurrent hemorrhages requiring retreatment were encountered in 3 patients secondary to stent infections (30%) at mean duration of 8 months. Neurologic morbidity resulted from stent thrombosis and stroke at 8 months in a single patient. Mortality was unrelated to CSP but was a result of palliative hospice care (n=3) at a mean of 2 months or natural disease progression (n=1) with documented patency of the stent at 6 months. CONCLUSIONS Acute life-threatening hemorrhage from CBS related to advanced HNC can be safely and effectively treated with CSP. However, potential delayed ischemic or infectious complications are common in the exposed or infected neck.
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Affiliation(s)
- H Shah
- University of Michigan Medical School, Ann Arbor, Michigan, USA
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