Willis Covered Stent Implantation for Treating Radiation Internal Carotid Blowout Syndrome in Nasopharyngeal Carcinoma

Abstract

Purpose: The study of Willis covered stent implantation on life-threatening hemorrhage from Radiation Internal Carotid Blowout Syndrome (RICBS) in patients with Nasopharyngeal Cancer (NPC) was evaluated in our hospital. Materials and Methods: Five NPC patients (3 male and 2 female patients) received Willis covered stent implantation from April 2011 to March 2017, in which radiation induced hemorrhage occurred in Internal Carotid Artery (ICA) was included in this study. The median age in the patient cohort was 56 (47-63). All patients were previously treated with radiotherapy (4 received IMRT and 1receivedheavy-ion RT). The median time was four years before the ICA ruptures after irradiation. The RICBS involved the C2 segment of the ICA in three patients and C3 in two patients. Results: All five patients’ ICA bleeding stopped immediately after the operation of Willis covered stent implantation. Follow-up mean time is 10 months. One patient died of suffocation (nasal hematorrhea) 2 weeks after the operation, in which the skull base is involved from recurrent lesions and associated dysphagia. One patient had rehaemorrhagia a week after the operation. One patient died of other accident 15 months after the operation. No adverse effects such as stroke and ischemia were found in all five patients during the follow-up period. Conclusion: The Willis covered stent implantation can immediately stop the bleeding caused by RICBS to save lives immediately. It is an effective and practical method to treat RICBS in NPC patients or other head and neck cancers patients, especially for the radiation-induced vascular events