Safety and effectiveness of endovascular embolization or stent‐graft reconstruction for treatment of acute carotid blowout syndrome in patients with head and neck cancer: Case series and systematic review of observational studies

Wong, Daniel Jun Yi; Donaldson, Christopher; Lai, Leon T.; Coleman, Andrew; Giddings, Charles; Slater, Lee-Anne; Chandra, Ronil V.

doi:10.1002/hed.25018

Cited by 37 publications

(28 citation statements)

References 21 publications

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“…However, 8%-14% of patients can incur a permanent ischemic insult from embolization of the affected artery [4]. In 2018, a study by Wong et al found that out of 266 patients, there was a 10.3% complication rate of ischemic events after embolization of the CCA or ICA and a 2.5% complication rate after stent reconstruction [5]. Rebleeding occurred in 31.9% of those treated with stents and in 9.1% of those with therapeutic endovascular occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…However, as demonstrated in a large metaanalysis of 559 patients by Bond et al, up to 20% of the patients who passed a BOT had a delayed ischemic event [6]. Endovascular reconstruction of the damaged artery with stents to decrease the risk of neurologic sequela in those who fail a BOT may be feasible, but can result in higher rates of rebleeding and delayed stroke [5,7].…”

Section: Discussionmentioning

confidence: 99%

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Successful Endovascular Treatment of Delayed Spontaneous Intracranial Internal Carotid Artery Blowout Following Orbital Exenteration and Radiation

Reed

Lyon

Benardete

2020

Cureus

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Most head and neck cancers require aggressive surgical resection followed by external beam radiation therapy. The carotid artery can be injured by surgery or radiation resulting in a delayed “blowout.” A patient who had undergone orbital exenteration for a lacrimal adenoid cystic carcinoma (ACC) followed by external beam radiation presented 16 years later with arterial bleeding from the orbit caused by “blowout” of the cavernous internal carotid artery (ICA). We review the literature on carotid blowout syndrome (CBS) and treatment. The patient was emergently transferred to a hybrid operating room and underwent a balloon occlusion test (BOT) and endovascular sacrifice of the ICA with no neurological deficits postoperatively. Emergent endovascular embolization is an effective treatment for an intracranial ICA blowout in this first reported case of a blowout through the orbit. Elevated radiation dose and lack of tissue coverage may put the cavernous ICA at risk for this delayed complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful Endovascular Treatment of Delayed Spontaneous Intracranial Internal Carotid Artery Blowout Following Orbital Exenteration and Radiation

Reed

Lyon

Benardete

2020

Cureus

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“…Regional metastases in the cervical lymph nodes and locally advanced disease in the pharynx and at the skull base can encase and erode into the great vessels of the neck. The internal jugular vein will typically collapse and occlude without ill effect, but the carotid artery system, if broached can lead to exsanguinating hemorrhage, the dreaded “carotid blowout.” Endovascular techniques such as embolization or more recently, covered stenting have provided significant temporization of such bleeds . This can have the good result of diverting death to another more acceptable cause (such as hypercalcemia of malignancy).…”

Section: Case: 59 Yof With Sentinel Carotid Hemorrhagementioning

confidence: 99%

Concurrent palliative care in the surgical management of head and neck cancer

McCammon

2019

Journal of Surgical Oncology

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Head and neck cancer affects vital functions of speech, swallowing, breathing, and appearance. Overall survival remains poor and symptom burden is high for both patients with incurable disease at the end of life and for long-term survivors. Early and concurrent palliative care helps guide treatment decision making and support quality of life during and after treatment. Both narrative competence and directive counsel can affect the concordance of patient goals and tolerance of treatment and outcomes. K E Y W O R D S decisional regret, directive counsel, narrative competence, supportive care, survivorship J Surg Oncol. 2019;120:78-84. wileyonlinelibrary.com/journal/jso

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“…Tumor encasement of the common carotid artery (CCA) and/or the internal carotid artery (ICA) in patients with advanced head and neck tumors represents a significant surgical challenge. The 5-year survival rate is about 5%-13% 1 partly due to risks of stroke or carotid blowout syndrome (CBS).Previous approaches to the prevention of CBS (e.g., surgical ligation, endovascular embolization, covered stent implantation) were palliative and most reports did not further solve the tumor burden [2][3][4] .Simple surgical management, e.g., peeling the tumor off the carotid wall, resection with ligation of the carotid artery, resection with or without revascularization, results in non R0 resection or intraoperative and postoperative complications, even the difficulty of the operation is a significant challenge for the surgeon 1,[5][6] .Therefore, we report our experience with combination of oncologic complete tumor resection and intravascular covered stent placement in patients with advanced head neck cancer.…”

Section: 、、、Introductionmentioning

confidence: 99%

Oncologic surgical resection with intravascular covered stent placement in patients with carotid artery encased by metastatic cancer---Our experience with 5 patients

Zhang

Jiang

et al. 2021

Preprint

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Importance: Tumor encasement of the common carotid artery (CCA) and/or the internal carotid artery (ICA) in patients with advanced head and neck tumors represents a significant surgical challenge. At present, there are few reports on the treatment approach that can achieve the maximal oncological resection and reduce the difficulty of operation without affecting the carotid artery blood flow. Objective: To examine whether the combination of oncologic complete tumor resection and intravascular covered stent placement is more advantageous in the management of advanced head and neck cancer. Design, Setting, and Participants: Five patients with advanced head and neck squamous cell carcinoma (AHNSCC) invading one side of the carotid artery were retrospectively enrolled. The contrast-enhanced computed Tomography (CT) and angiography were performed to assess the severity of extrinsic tumor compression to the carotid artery. Covered stent was placed intra-arterially at least 1 cm proximal and distal beyond the area of tumor involvement. The tumor and the involved carotid artery were resected, and pectoralis major flap transfer was utilized for coverage of the great vessels supported with intra-arterial covered stent. Main Outcomes and Measures: Efficacy of oncologic complete tumor resection combined with endovascular stent placement. Results: The post-stenting demonstrated an improvement in the appearance and caliber of the affected carotid artery. Four patients experienced transient bradycardia and hypotension. All five patients underwent R0 resection. Postoperatively, the flap all had rich vascularity and healing. Three patients underwent adjuvant radiotherapy or chemoradiation. With median follow-up 6.5 months, one patient died of multiple organ failures at 6.5 months after surgery; one patient developed tracheal stoma recurrence and treated with salvaged surgery; the three other patients had no disease recurrence in their last follow-ups. Conclusions and Relevance: Surgical resection with intravascular covered stent placement could potentially achieve the maximal oncological resection without compromise carotid artery blood flow in patients with carotid artery encased head and neck cancer.

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Safety and effectiveness of endovascular embolization or stent‐graft reconstruction for treatment of acute carotid blowout syndrome in patients with head and neck cancer: Case series and systematic review of observational studies

Abstract: Both embolization and stent grafts are safe therapeutic options for acute carotid blowout syndrome. Embolization for ICA/CCA carotid blowout syndrome was associated with higher risks of procedural stroke and lower recurrent bleeding compared to stent grafts.

Cited by 37 publications

References 21 publications

Successful Endovascular Treatment of Delayed Spontaneous Intracranial Internal Carotid Artery Blowout Following Orbital Exenteration and Radiation

Successful Endovascular Treatment of Delayed Spontaneous Intracranial Internal Carotid Artery Blowout Following Orbital Exenteration and Radiation

Concurrent palliative care in the surgical management of head and neck cancer

Oncologic surgical resection with intravascular covered stent placement in patients with carotid artery encased by metastatic cancer---Our experience with 5 patients

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