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

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.

Follow-up for covered stent treatment of carotid blow-out syndrome in patients with head and neck cancer

“…Medication alone may be insufficient to cure the colonized infection, and surgical retrieval of an infectious stent may be required. 3 In addition to localized abscess formation adjacent to the stent graft, distal embolization resulting in cerebral abscess and carotid thrombosis have been reported. 13 Prophylactic antibiotics may be needed if CSP is performed under these conditions.…”

Risk Factors for Hemorrhage After Chemoradiation for Oropharyngeal Squamous Cell Carcinoma

“…5,11 Even when intervention is successful, rates of neurological morbidity approach 60%, chiefly as a result of brain hypoxia. 8,12 In this article, we analyze 139 patients with OSCC who underwent concomitant chemoradiation therapy without surgery to identify risk factors for life-threatening oropharyngeal hemorrhage.…”

Endovascular Treatment for Carotid Blowout Syndrome after Radiation: A Case Report

“…After the deployment contrast extravasation was still demonstrated ( Figure 2) so a second Atrium ADVANTA V12 ™ with the same size was placed carotid blowout that underwent surgical intervention had a higher neurologic complication rate and mortality rate when compared with those patients that underwent an endovascular approach [15]. Current evidence shows that there was no significant difference in technical and haemostatic outcomes between the reconstructive and deconstructive endovascular methods because permanent vessel occlusion resulted in higher immediately cerebral ischemia and stent grafting induced the more potentially delayed complications, such as infection, rebleeding, and stent thrombosis [4,7]. According to some authors when the lesion involves branches of the external carotid artery, destructive techniques are usually used with coil embolization of these vessels.…”

“…CBS is more frequent in cases of radiation induced necrosis, recurrent tumours, wound complications from neck dissection, or vessel erosion from pharyngocutaneous fistulas. Carotid blowout syndrome (CBS) resulting from radiotherapy alone is an uncommon complication and is usually associated with sudden, catastrophic bleeding [2][3][4]. The mortality rate was reported to range from 3% to over 50% in the literature [5].…”