Stent pretreatment for internal carotid artery exposed to necrotic lesions in nasopharyngeal carcinoma

Abstract

Background: Post radiation nasopharyngeal necrosis (PRNN) invading the internal carotid artery (ICA) contributes to the death of 69.2–72.7% of PRNN patients. ICA occlusion is an effective treatment to avoid fatal bleeding, while some patients are intolerant. We present a novel method that allows for these patients without interrupting blood flow through the ICA. Methodology: This study enrolled patients with PRNN-invaded ICA who were not suitable for ICA occlusion from April 2020 to November 2022. ICA stent pretreatment was performed in the 36 patients and followed the endoscopic nasopharyngectomy (ENPG) or conservative treatment for PRNN. We report the survival outcome and incidence of complications after stent implantation and compare the survival outcomes of ENPG and conservative treatment for PRNN followed by stent implantation. Results: ICA stent pretreatment was performed in the 36 enrolled patients, among which 14 underwent ENPG, and 22 received conservative treatment. 27.8% patients died after a median follow-up of 15 months. The Kaplan-Meier estimates of overall survival were higher in the ENPG group than in the conservative treatment group. Karnofsky performance status (KPS) was significantly higher in the ENPG group than in the non-ENPG group. Conclusions: The innovative application of ICA stents is a promising treatment to improve outcomes in patients with PRNN invading the ICA who are unsuitable for ICA embolization, especially when followed by endoscopic surgery. However, methods to avoid postoperative cerebral ischemia and nasopharyngeal hemorrhage still require further study.

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

“…Application of endovascular techniques including arterial occlusion or stent insertion may help decrease the morbidity and mortality in patients with types 1 and 2 CBS ( 7 ). Previous literatures have demonstrated that the application of ICA embolization could promote nasopharyngeal tissue healing and prolong the survival of NPC patients, compared with who did not have the ICA embolization ( 8 , 9 ). Therefore, endovascular occlusion was once the mainstream treatment, but it is only suitable for patients whose balloon occlusion test (BOT) results are negative.…”

Assessment of Prophylactic Internal Carotid Artery Management in Postradiation Nasopharyngeal Necrosis Patients

“…Importantly, the leading cause of death in PRNN patients is massive hemorrhage resulting from internal carotid artery (ICA) rupture 10,13 . Several studies have explored strategies for preventing ICA rupture and hemorrhage, such as prophylactic ICA occlusion and ICA stent pretreatment 14‐16 . However, when PRNN progresses to ICA rupture and massive hemorrhage, emergent surgical strategies have been limited 17 …”

“…10,13 Several studies have explored strategies for preventing ICA rupture and hemorrhage, such as prophylactic ICA occlusion and ICA stent pretreatment. [14][15][16] However, when PRNN progresses to ICA rupture and massive hemorrhage, emergent surgical strategies have been limited. 17 In this large-scale study, half of the target patients overlaps with those in Yang et al's research.…”