Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer ‐ Related Carotid Blowout Syndrome

Abstract

Objective/Hypothesis: To investigate the endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass in the management of patients with head and neck cancer-related carotid blowout syndrome (CBS).Study Design: Retrospective case series.Methods: Retrospective analysis of clinical data of patients with head and neck cancer-related CBS treated by endovascular intervention and/or EC/IC vascular bypass, analysis of its bleeding control, neurological complications, and survival results.Results: Thrity-seven patients were included. Twenty-five were associated with external carotid artery (ECA); twelve were associated with internal or common carotid artery (ICA/CCA). All patients with ECA hemorrhage were treated with endovascular embolization. Of the 12 patients with ICA/CCA hemorrhage, 9 underwent EC/IC bypass, 1 underwent endovascular embolization, and 3 underwent endovascular stenting. For patients with ECA-related CBS, the median survival was 6 months, and the 90-day, 1-year, and 2-year survival rates were 67.1%, 44.7%, and 33.6%, respectively; the estimated rebleeding risk at 1-month, 6-month, and 2-year was 7.1%, 20.0%, and 31.6%, respectively. For patients with ICA/CCA-related CBS, the median survival was 22.5 months, and the 90-day, 1-year, and 2-year survival rates were 92.3%, 71.8%, and 41.0%, respectively; the estimated rebleeding risk at 1 month, 6 months, and 2 years is 7.7%,15.4%, and 15.4%, respectively. ICA/CCA-related CBS patients have significantly longer survival time and lower risk of rebleeding, which may be related to the more use of EC/IC vascular bypass as a definite treatment.Conclusions: For patients with ICA/CCA-related CBS, if there is more stable hemodynamics, longer expected survival, EC/IC vascular bypass is preferred.

Endovascular Treatment for Primary Tumor Hemorrhage in Oropharyngeal Carcinoma: A Report of Two Cases

“…ET of acute arterial hemorrhage has been primarily used in radiology and neurosurgery, and most reports have not specified the responsible vessel or clinical outcomes [1][2][3][5][6][7][8][9][10][11]. There are few reports of hemorrhage from primary head and neck cancer (Table 1).…”

Safety and efficacy of protective stent insertion to prevent carotid blowout syndrome at the distal internal carotid artery in nasopharyngeal carcinoma patients: a comparison with endovascular occlusion

“…Though BOT was used to identify patients at high risk for immediate ischemic complications, 3.7–10% of ischemic events involved negative BOT results ( 15 - 17 ). Extracranial/intracranial vascular bypass to prevent CBS was evaluated in a small case series, with a reported median survival of 6 months ( 18 ), but surgical trauma and the poor general condition of NPC patients decrease the acceptability of this treatment option. However, compared to coil embolism and by-pass surgery, stenting might become a more feasible and safer technique, making it a suitable alternative ( 19 ).…”

Survival analysis of a comprehensive treatment strategy for internal carotid artery blowout syndrome by nasopharyngeal carcinoma

“…[9][10][11] Ping-An Wu et al proposed the treatment of extra-intracranial vascular bypass for CBS. 12 Our strategy is to emphasize the equally importance of endoscopic surgery to remove nasopharyngeal necrosis and recurrent nasopharyngeal carcinoma, based on the occlusion or reconstruction of blood vessels. This avoids the fragmentation of related disciplines and closely integrates cooperation between disciplines due to carotid artery injuries related to NPC.…”

“…In recent years, the treatment of choice for CBS is intravascular treatment, including coils occlusion, flow diverters, and covered stent implantation 9–11 . Ping‐An Wu et al proposed the treatment of extra‐intracranial vascular bypass for CBS 12 …”