E-240 Endovascular thrombectomy beyond 24 hours of last known well: a systematic review and meta-analysis

Abstract

the utility and current indications for intra-arterial embolization in the management of these complex patients. Methods A comprehensive literature review was performed using PubMed on intra-arterial embolization in head and neck cancer. Discussion Intra-arterial embolization is primarily utilized in two methods in head and neck cancer: treatment of hypervascular tumors and chemoembolization of advanced cancers. The most common and well-established use of intra-arterial embolization is for head and neck paragangliomas. These are hypervascular tumors that have long been treated pre-operatively with embolization to decrease the morbidity and mortality of surgery with a well-established safety profile. Since the Society of NeuroInterventional Surgery 2012 Head, neck, and brain tumor embolization guidelines 1 this has been a pivotal aspect of these patients' treatment plan and has been repeatedly shown to have technical success rates of 90+% with minimal complications. [2][3][4] Advances in arterial embolization continue with utilization of newer agents, including success with direct injection of Squid liquid embolic agent. 5 Embolization is also commonly used as a salvage therapy to control bleeding in patients with advanced or recurrent head and neck cancer. In a retrospective review, Shetty et al show that intra-arterial salvage embolization in patients with unresectable tumors is safe and provides adequate control of bleeding with only 3/26 (11.5%) having recurrent bleeding post-procedure. 6 Others have demonstrated the use of endovascular embolization in palliative patients with high success rates and the ability of patients to remain home with loved ones prior to this death. 7 More recently, tumor chemoembolization has grown in popularity with advances in intra-arterial catheters for superselective delivery. Attempts have been made over the years to utilize this technique in advanced head and neck cancers, including attempts to use carboplatin microcapsules, 8 cisplatin crystals, 9 and more recently with drug-eluting embolic agents. 10 11 Drug-eluting embolic agents mark the next step in the progression of intra-arterial treatment of head and neck tumors and provide a promising new subset of patients. Studies have shown objective response rates in recurrent and advanced head and neck cancers from 25-60% and disease control rates of 69-100% with minimal adverse effects, showing superior efficacy and a more favorable safety profile compared to conventional chemoembolization. Conclusions Intra-arterial embolization of head and neck cancers is safe and efficacious to treat both hypervascular tumors and for chemoembolization of complicated advanced cancers.