Evaluation of the outcomes of endovascular management for patients with head and neck cancers and associated carotid blowout syndrome of the external carotid artery

Chang, Feng-Chi; Luo, Chao-Bao; Lirng, Jiing Feng; Lin, Chung Jung; Wu, Hsiu‐Mei; Hung, Sheng-Che; Guo, Wan‐Yuo; Teng, Michael Mu Huo; Chang, Cheng Yen

doi:10.1016/j.crad.2013.02.015

Cited by 17 publications

(49 citation statements)

References 15 publications

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“…The clinical significance of this finding is unclear due to the small sample size and dependence on other confounding factors, as significance was lost upon inclusion in a multivariate model. Our rate of rebleeding falls at the higher end of previously reported rates ranging from 13-27% 5,6,12,13 and demonstrates the temporary nature of many of the interventions performed for CBS despite initial technical success.…”

Section: Discussionmentioning

confidence: 41%

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

Liang

Guedes

Duvvuri

et al. 2016

Journal of Vascular Surgery

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Background The purpose of this study was to examine outcomes of a patient cohort undergoing intervention for carotid blowout syndrome (CBS) associated with head and neck cancer. Methods Patients with head and neck cancer who presented with carotid-distribution bleeding from 2000-2014 were identified in the medical record. Primary outcomes were short and mid-term mortality and recurrent bleeding. Standard statistical methods and survival analysis were used to analyze study population characteristics and outcomes. Results Thirty-seven patients were included in the study. The mean age was 60.1±11.4 (74% male). All malignancies were squamous cell type, stage IV, in a variety of primary locations: 32% oral cavity, 24% larynx, 16% superficial neck, with the remainder in the oro, naso, and hypopharynx. 51% of bleeds were of common carotid, 29% external carotid, and 19% internal carotid origin. 68% presented with acute hemorrhage, 24% with impending bleed, and 8% with threatened bleed. All patients underwent intervention: 38% received endovascular coil embolization, 30% stent grafts, 22% surgical ligation, and 10% primary vessel repair or bypass grafting. 10.8% of patients had perioperative stroke; other major complications were rare. Sixteen recurrent bleeding episodes involving 12 arteries occurred in 11 patients (29.73%). Median rebleeding time was seven days (IQR 6-49). Estimated recurrent bleeding risk at 30-days and 6 months was 24% and 34% respectively. 91.9% of patients survived to hospital discharge. 90-day and 1-year estimated survival was 60.9% and 36.6% respectively. Conclusions CBS associated with head and neck cancer carries poor mid- and long-term prognoses; however, mortality may be related more to the advanced stage of disease rather than carotid involvement or associated intervention. Both surgical and endovascular approaches may be efficacious in cases of acute hemorrhage but carry a significant risk of periprocedural stroke and recurrent bleeding.

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Section: Discussionmentioning

confidence: 41%

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

Liang

Guedes

Duvvuri

et al. 2016

Journal of Vascular Surgery

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“…Carotid blowout management has been widely discussed during the last decade in English language literature [1–3]. This is due both to technical improvements and to easier access to interventional radiology in many hospitals.…”

Section: Discussionmentioning

confidence: 99%

Impending Carotid Blowout Stabilization Using an LT-D Tube

Desuter

Grégoire

Gardiner

et al. 2014

Case Reports in Otolaryngology

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Adequate stabilization of a patient presenting with a carotid blowout is one of the most challenging issues an on-call ENT surgeon can be confronted with. Reducing the bleeding and securing the airway are essential before more definitive management. We present the case of a 72-year-old patient with head and neck cancer who arrived at the emergency room with a carotid blowout and who was successfully stabilized using a King LT-D ventilation tube.

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“…Carotid blowout syndrome (CBS),that is, rupture of the extracranial carotid arteries or their major branches, is one of the most feared complications, with a reported incidence of 3 to 4% in patients with HNC. [3][4][5][6][7][8][9][10] CBS is associated with 60% morbidity and 40% mortality. 3,4,6,7,[10][11][12][13] In patients with advanced HNC, risk factors for the development of CBS are radiation, stripping of the carotid artery during surgery, skin breakdown, and development of mucocutaneous fistula.…”

Section: Introductionmentioning

confidence: 99%

“…However, more recently developed endovascular techniques, including selective embolization and reconstruction with covered stent grafts, have become the mainstay of treatment. [3][4][5][6][7][8]10,11,15 Immediate complications associated with the use of covered stent grafts after CBS have been extensively reported and include acute thromboembolism and iatrogenic dissection. Mid-and long-term complications may involve rebleeding (13-44% incidence) and stent thrombosis associated or not symptomatic ischemic cerebrovascular accidents.…”

Section: Introductionmentioning

confidence: 99%

Management of Cutaneously Exposed Carotid Stents in Recurrent and Unresectable Head and Neck Cancer

Beer‐Furlan

Heilingoetter

Rayle

et al. 2020

J Neurol Surg B Skull Base

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Objective Carotid blowout syndrome (CBS) is a rare but potentially life-threatening complication of head and neck cancer (HNC) treatment. Patients with CBS are managed with covered stents, limited published information exists regarding the management of delayed complications, specifically cutaneous exposure of stents. Here, we present our experience managing cutaneously exposed carotid artery stents (CAS) in patients with recurrent and unresectable HNC. Methods A single-institution retrospective analysis was performed to identify recurrent HNC patients who underwent CAS placement for CBS and complicated with cutaneous exposure of the stent between 2014 and 2016. Medical records were reviewed with attention to treatment history, pre-, intra-, and postoperative courses, anticoagulation needs, and durability of the reconstruction. Results We identified three patients who presented with a right CAS fully exposed in a large, ulcerative wound. All patients underwent a right pectoralis major myocutaneous flap (PMMF) to cover the exposed stent within 30 days of presentation to our institution. Two of three patients attained adequate coverage of the stent for more than 30 days, while one experienced partial flap dehiscence within 12 days. Two patients developed postoperative chest hematomas, which were managed conservatively. Two of three patients were able to undergo further palliative adjuvant treatments within 60 days of the initial surgical procedure. Conclusion In this small series, durable coverage of an exposed carotid artery with PMMF was successful in two of three patients with extensive disease burden and complex prior treatment history. No mortalities occurred within 30 days postoperatively.

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Evaluation of the outcomes of endovascular management for patients with head and neck cancers and associated carotid blowout syndrome of the external carotid artery

Cited by 17 publications

References 15 publications

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

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

Impending Carotid Blowout Stabilization Using an LT-D Tube

Management of Cutaneously Exposed Carotid Stents in Recurrent and Unresectable Head and Neck Cancer

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