Intervening in the Acute Phase of Postradiation Carotid Blowout Syndrome

Abstract

Introduction Acute carotid blowout syndrome (aCBS) is a severe complication of head and neck cancer (HNC). It can be defined as a rupture of the extracranial carotid arteries, or one of their branches, that causes life-threatening hemorrhage, and which nowadays can be treated with urgent endovascular intervention. Objective We retrospectively evaluate the endovascular management of aCBS and its outcome in years of survival. Methods Retrospectively, we describe our experience with endovascular control of aCBS in patients treated for HNC. We review the characteristics, pathology, endovascular treatment and morbidity and assess the gain in life years. Results Nine individuals were included in this study. Four patients had been previously diagnosed with laryngeal squamous cell carcinoma (SCC), one with paranasal SCC, one with nasopharyngeal carcinoma and three with oral or maxillary adenocarcinoma. All subjects underwent radiotherapy and surgical excision to different extents. Twelve endovascular procedures were performed for injuries to the internal carotid artery (n = 3; 25%), external carotid artery (n = 1; 7%) or one of their branches (n = 8; 67%). Deconstructive methods were used in nine procedures, and three procedures were mainly reconstructive with deployment of covered stents. Total control of bleeding was achieved in all individuals with no intraprocedural complications. Conclusion Endovascular therapy is an effective alternative for the management of exsanguinating CBS. In our series, this palliative therapy increased the overall patient survival by an estimated 9 months.

Clinicopathological Factors and Prognosis of Massive Hemorrhage After Radiotherapy for Nasopharyngeal Carcinoma

“…However, in the case of internal carotid artery hemorrhage, vascular interventional embolization or a covered stent may be used, depending on the pattern of intracranial artery vascularization. Jung et al found that the average survival time in such patients could be increased by 9 months through the use of interventional therapy [18].…”

Treatment of a patient with carotid blowout syndrome with a new deconstructive embolization technique

“…Carotid blowout syndrome (CBS) is one of the serious life-threatening complications seen in 3%-4% of head and neck cancers [1] . It usually occurs by forming erosion in the head and neck vessels of patients with advanced cancer who have received radiotherapy [2] . Mortality rates have been reported to be over 50% [ 2 , 3 ].…”

“…It usually occurs by forming erosion in the head and neck vessels of patients with advanced cancer who have received radiotherapy [2] . Mortality rates have been reported to be over 50% [ 2 , 3 ]. There are different treatment approaches such as open surgical ligation, endovascular treatment techniques, and extracranial/intracranial vascular bypass [ 2 , 3 ].…”

Embolization for Carotid Blowout in Head and Neck Cancer: Case Report of Five Patients

“…2 Recently, endovascular intervention by means of balloon occlusion, coil embolization or covered stent-graft placement has been advocated as first line of treatment for CBS. 6,7…”