Complications of Carotid Blowout Syndrome in Patients with Head and Neck Cancers Treated by Covered Stents

Abstract

<jats:p> The purpose of this study was to improve clinical assessment of carotid-blowout syndrome (CBS) in patients with head-and-neck cancers and with covered stents by evaluating immediate and delayed complications of reconstructive management. Eleven such patients were treated with self-expandable covered stents. We evaluated immediate and delayed complications by assessing clinical and imaging findings. Technical success and immediate hemostasis were achieved in all patients. Immediate complications were noted in four patients (36.4%), including thromboembolism in three patients and, in one patient, dissection of the carotid artery and type III endoleak by the overlapped self-expandable stent causing rebleeding. Delayed complications were noted in eight patients (72.7%), including six episodes of rebleeding in five patients, distal marginal stenosis in five patients, and delayed carotid thrombosis in three patients (one with brain abscess formation). We suggest close follow-up of the patients and aggressive re-intervention of their complications to improve outcomes. </jats:p>

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

“…1,4,6 Despite this advancement, there is a rate of 0%-15% of cerebral ischemic complications with permanent balloon occlusion of the ICA or CCA. 1,[4][5][6][7][8] The ischemic complications from vessel-deconstruction strategies subsequently led to the use of endovascular stents as a possible option. Many initial reports suggested that endovascular stents could not only reconstruct the arterial wall but also maintain vessel patency and decrease ischemic complications.…”

“…Zero percent to 15% of patients with CBS who are managed with permanent balloon occlusion may develop immediate or delayed cerebral ischemia as a consequence of Ն1 factor, such as an incomplete circle of Willis, thromboembolism arising from an acutely occluded carotid artery, and delayed collateral failure. 1,[4][5][6][7][8] Given these results, there has been an interest in treating CBS with the deployment of covered stents. Self-expanding covered stents reconstruct the vessel wall with relatively atraumatic deployment, excluding extraluminal vessel pathology and maintaining intraluminal blood flow to the intracranial circulation, thus possibly limiting ischemic complications and immediately controlling the hemorrhage.…”

“…To date, there remain limited data on the use of covered stents for the treatment of CBS in patients with acute life-threatening hemorrhage in the setting of HNC, with complication rates ranging between 0% and 27%. [8][9][10][11][12] The purpose of this study was to evaluate the safety and efficacy of CSP in achieving immediate hemostasis in patients with acute life-threatening hemorrhage in the context of HNC presenting with CBS.…”

Endovascular treatment of iatrogenic penetrating trauma of the carotid artery: case report

“…1,2 The endovascular technique is a less invasive option, offering lower morbidity and mortality for treatment of carotid traumas and allowing preservation of the common carotid artery and cerebral flow, with the added advantage that it demands less time in surgery than conventional procedures. [7][8][9][10] In the literature we found reports of carotid traumas treated with a wide variety of endoprostheses, both self-expanding and balloon-expanded. [6][7][8][9]11,12 In the case described here, a self-expanding Viabahn endoprosthesis was used because of its flexibility, since the patient had a tortuous carotid, and because of the simple and rapid release mechanism, which was important because of the need to release it at the same moment that the catheter was removed manually.…”

“…[7][8][9][10] In the literature we found reports of carotid traumas treated with a wide variety of endoprostheses, both self-expanding and balloon-expanded. [6][7][8][9]11,12 In the case described here, a self-expanding Viabahn endoprosthesis was used because of its flexibility, since the patient had a tortuous carotid, and because of the simple and rapid release mechanism, which was important because of the need to release it at the same moment that the catheter was removed manually. An 8 × 50 mm endoprosthesis was used in a 7 mm target artery, making correct placement possible and preventing leakage or migration.…”