Predisposing factors, management, and prognostic evaluation of acute carotid blowout syndrome

Lu, Hsueh‐Ju; Chen, Kuo-Wei; Chen, Ming-Huang; Chu, Pen–Yuan; Tai, Shyh Kuan; Wang, Ling Wei; Chang, Peter Mu Hsin; Yang, Muh Hwa

doi:10.1016/j.jvs.2013.04.056

Cited by 54 publications

(89 citation statements)

References 33 publications

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“…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.…”

Section: Discussioncontrasting

confidence: 71%

“…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: 42%

“…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 .…”

Section: Discussionmentioning

confidence: 99%

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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: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 42%

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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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“…The spectrum of CBS entails challenging scenarios, which require rapid recognition and prompt, often simultaneous, initiation of diagnostic and therapeutic modalities by surgeons and neurointerventionalists. This study affirms the many predisposing risk factors associated with CBS, such as a history of chemoradiation, reirradiation, soft tissue necrosis, tumor recurrence, and poor nutrition . The vast time intervals between treatment and timing of blowout in case 3 emphasize the point that radiation produces long‐term tissue changes.…”

Section: Discussionsupporting

confidence: 71%

“…This study affirms the many predisposing risk factors associated with CBS, such as a history of chemoradiation, reirradiation, soft tissue necrosis, tumor recurrence, and poor nutrition. 2,9 The vast time intervals between treatment and timing of blowout in case 3 emphasize the point that radiation produces long-term tissue changes. This delayed presentation of CBS has been noted in the literature before and may represent only a minor subset of the cases.…”

Section: Discussionmentioning

confidence: 99%

Contemporary management of carotid blowout syndrome utilizing endovascular techniques

et al. 2016

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

Yuan

Zhou

et al. 2021

The Laryngoscope

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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.

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Predisposing factors, management, and prognostic evaluation of acute carotid blowout syndrome

Cited by 54 publications

References 33 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

Contemporary management of carotid blowout syndrome utilizing endovascular techniques

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

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