Prediction of Borderzone Infarction by CTA in Patients Undergoing Carotid Embolization for Carotid Blowout

Lee, B.-C.; Lin, Yen‐Heng; Lee, C.-W.; Liu, Hon‐Man; Huang, Adam

doi:10.3174/ajnr.a5672

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…6 Evaluation of the COW could predict the collateral condition of the patient undergoing carotid embolization. 7 Therefore, a covered stent should be reserved for a bridging procedure indicated for patients with a poor COW or intolerance to an occlusion test. 8 In our patient, the COW integrity was robust; therefore, we selected deconstructive embolization as the treatment procedure.…”

Section: Discussionmentioning

confidence: 99%

Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome

Lin

Lee

2020

Neurointervention

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Carotid blowout syndrome (CBS) is a fatal complication of head and neck cancer. Endovascular treatment, particularly deconstructive embolization, is effective for CBS, but it might result in thromboembolic events. We report the case of a 57-year-old man with underlying recurrent head and neck cancer who had CBS. The patient received endovascular embolization of the right internal, external, and common carotid arteries. Right internal carotid artery to middle cerebral artery embolic occlusion was noted immediately after the procedure, and left-sided weakness and facial palsy were found. Ipsilateral suprabulbar cervical internal carotid artery puncture was performed under fluoroscopic guidance, and rescue suction thrombectomy was successful. The patient had no significant neurological sequela. Transcarotid intraarterial thrombectomy is a reasonable method for managing postembolization large vessel occlusion, even in the neck, after irradiation.

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Section: Discussionmentioning

confidence: 99%

Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome

Lin

Lee

2020

Neurointervention

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“…Twenty‐eight observational studies met all inclusion criteria and were included in the systematic review. There were 18 studies on PAO, 1,4–20 7 studies on stenting 21–27 and 3 studies 28–30 that reported both interventions.…”

Section: Resultsmentioning

confidence: 99%

Deconstructive versus reconstructive approach to internal carotid artery blowout in radiated nasopharyngeal carcinoma: A tertiary center experience and systematic review

Gopinathan

Ong

et al. 2023

Head & Neck

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The objective of this study was to compare the outcomes of parent artery occlusion (PAO) versus stent-assisted reconstruction in radiated nasopharyngeal carcinoma (NPC) patients with internal carotid artery (ICA) blowouts. A retrospective review from our institution (2011-2021) and systematic review of Pubmed and Embase (1995-2022) was performed. Twenty-eight eligible studies were identified. Eighty-six PAOs and 37 stent-assisted reconstructions were analyzed, including 11 PAOs and 5 stents from our institution. Stents were associated with significantly higher incidence of overall re-bleeding (16.2% [95% CI 7.4-31.9] vs. 4.6% [95% CI 1.3-13.5], p = 0.047), delayed stroke (5.4%[95% CI 1.3-19.4] vs. 0%, p = 0.034) and reduced median survival (7.1 [95% CI 3.8-14.0] months vs. 29.0 [95% CI 9.4-63.4] months, p = 0.017) compared to PAO. There were no significant differences in terms of overall stroke, infection, extruded/migrated foreign body, and peri-procedure death. PAO is preferred over reconstructive treatment in patients with adequate collateral circulation.

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“…Among our vascular inflammation. Otherwise, CTA can also be used to predict border zone infarction after permanent common carotid artery and/or ICA occlusion by measuring the collateral vessels of the circle of Willis [7]. However, DSA was essential to clarify the sites of pseudoaneurysm, degree of vascular damage, and especially their treatment.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of massive epistaxis and pseudoaneurysms in nasopharyngeal carcinoma after radiotherapy

Zeng

2021

Preprint

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Objectives This article focuses on massive epistaxis and pseudoaneurysm in patients with NPC after radiotherapy and discusses clinically relevant treatment strategies. Design Retrospective the medical data of NPC patients with massive epistaxis after radiotherapy and review the English literature over the past 10 years. Setting Otorhinolaryngology department in the First Affiliated Hospital of Nanchang University. Participants 21 patients with massive epistaxis after radiotherapy for NPC. Main outcome measures Characteristics and related causes of massive epistaxis or pseudoaneurysms were analyzed in terms of the clinical stage of NPC, course of radiotherapy, and affected artery. An analysis was performed on the methods of endovascular interventional treatment of such pseudoaneurysms. Results 19 cases were accompanied with bone destruction of the skull base; 13 cases were found tumor recurrence; 15 cases were in stage III or IV of NPC; 14 cases were combined with pseudoaneurysms. Analysis with the imaging of pseudoaneurysms, we found that the petrous ICA was the most predilection site. There were 11 out of 14 pseudoaneurysms had sentinel hemorrhage in the initial phase. All 14 pseudoaneurysm patients were underwent endovascular interventional therapy, but one died from hemorrhagic shock during the procedure. There were no rebleeding again among other patients. Conclusions Pseudoaneurysm could cause massive epistaxis with high mortality. The formation of a pseudoaneurysm was closely associated with a high carcinoma stage, re-radiotherapy, and local bone destruction and infection. Most cases had sentinel epistaxis. The imaging material prompted that pseudoaneurysm had a predisposition to the petrous part of the ICA, while the preferred therapy was endovascular embolization treatment. Key poits 1.Patients with massive epistaxis mean a single nasal bleeding volume exceeded 100 ml, or cumulative bleeding volume was more than 300 ml. 2.Patients who presented with active oronasal bleeding should be rapidly managed by nasal packing. 3.When there is hemorrhagic shock, patients should undergo endotracheal intubation and blood transfusion before being transferred to the otorhinolaryngology department. 4.CTA and DSA are recommended for patients with massive epistaxis associated with NPC after radiotherapy. 5.Interventional embolization is recommended to patients with pseudoaneurysm.

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Prediction of Borderzone Infarction by CTA in Patients Undergoing Carotid Embolization for Carotid Blowout

Cited by 9 publications

References 28 publications

Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome

Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome

Deconstructive versus reconstructive approach to internal carotid artery blowout in radiated nasopharyngeal carcinoma: A tertiary center experience and systematic review

Retrospective analysis of massive epistaxis and pseudoaneurysms in nasopharyngeal carcinoma after radiotherapy

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