Carotid blowout in patients with head and neck cancer: Associated factors and treatment outcomes

Abstract

After completion of treatment in patients with head and neck cancer, carotid blowout was an uncommon complication with catastrophic results. Recognition of associated factors helps physicians to identify those at risk.

Outcomes of interventions for carotid blowout syndrome in patients with head and neck cancer

“…Reports have suggested a higher stroke rate with surgical or endovascular ligation/occlusion compared to endovascular graft repair 4,7,12 , but stroke rates were not different between treatment modalities in our cohort. Endovascular occlusion of the internal and common carotid arteries is not commonly performed in our institution, with stent-grafts being the preferred endovascular solution in these vascular beds.…”

“…The majority of surgical ligation procedures occurred in patients presenting with acute hemorrhage, necessitating emergency operation and preventing usage of adjuncts such as a balloon occlusion testing. Variable stroke rates have been seen in different cohorts ranging from 0-15% 4,7,12 .…”

“…Covered stent usage has been frequently utilized in those patients who have elective failed balloon test occlusion or are at risk for major neurological complications secondary to compromised cerebral perfusion and have been successfully used for the treatment of acute hemorrhage as well 4,5 . Despite the immediate hemostasis that covered stents provide, patients remain at risk for immediate complications such as stroke as well as long-term morbidities including recurrent bleeding, thrombosis, and infection 6,7 . The purpose of the current study was to examine short and midterm mortality and recurrent bleeding outcomes for patients with head and neck cancer complicated by CBS in a large tertiary center.…”

High-LET radiotherapy for adenoid cystic carcinoma of the head and neck: 15 years’ experience with raster-scanned carbon ion therapy

“…Though the overall incidence in this large patient cohort may be low, we still wish to advise caution when treating patients with dose escalation following extensive resections in or near the skull base. While carotid blowout may be more common in re-irradiation of head and neck tumors [38,42], prior surgery and doses >70 Gy were identified as risk factors [42], the risk of carotid artery damage and permanent CSF leakage may limit further dose escalation at these sites.…”

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

“…Some authors suggest also a role of infections in CBS and the relation of bacterial inflammation as a cause of vasa vasorum thrombosis, and secondary arterial wall damage. Neck surgery is another significant factor related to CBS, because this kind of surgeries could compromise the nutrition of the carotid artery during cervical nodes resection, resulting in injury to the adventitial layer, and this deleterious effect occurs independently of radiation [6,14]. In the HNC population with previous surgery or radiotherapy, a high index of suspicion must be maintained for CBS in patients presenting with any recent history of oral bleeding or haemorrhaging from an exposed neck wound [11].…”