Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer - Related Carotid Blowout Syndrome

Laryngoscope. 2021 Jul;131(7):1548-1556. doi: 10.1002/lary.29427. Epub 2021 Feb 11.

Abstract

Objective/hypothesis: To investigate the endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass in the management of patients with head and neck cancer-related carotid blowout syndrome (CBS).

Study design: Retrospective case series.

Methods: Retrospective analysis of clinical data of patients with head and neck cancer-related CBS treated by endovascular intervention and/or EC/IC vascular bypass, analysis of its bleeding control, neurological complications, and survival results.

Results: Thrity-seven patients were included. Twenty-five were associated with external carotid artery (ECA); twelve were associated with internal or common carotid artery (ICA/CCA). All patients with ECA hemorrhage were treated with endovascular embolization. Of the 12 patients with ICA/CCA hemorrhage, 9 underwent EC/IC bypass, 1 underwent endovascular embolization, and 3 underwent endovascular stenting. For patients with ECA-related CBS, the median survival was 6 months, and the 90-day, 1-year, and 2-year survival rates were 67.1%, 44.7%, and 33.6%, respectively; the estimated rebleeding risk at 1-month, 6-month, and 2-year was 7.1%, 20.0%, and 31.6%, respectively. For patients with ICA/CCA-related CBS, the median survival was 22.5 months, and the 90-day, 1-year, and 2-year survival rates were 92.3%, 71.8%, and 41.0%, respectively; the estimated rebleeding risk at 1 month, 6 months, and 2 years is 7.7%,15.4%, and 15.4%, respectively. ICA/CCA-related CBS patients have significantly longer survival time and lower risk of rebleeding, which may be related to the more use of EC/IC vascular bypass as a definite treatment.

Conclusions: For patients with ICA/CCA-related CBS, if there is more stable hemodynamics, longer expected survival, EC/IC vascular bypass is preferred.

Level of evidence: 4 Laryngoscope, 131:1548-1556, 2021.

Keywords: Carotid blowout syndrome; covered stent; embolization; endovascular; vascular bypass.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carotid Artery Diseases / etiology
  • Carotid Artery Diseases / mortality
  • Carotid Artery Diseases / surgery*
  • Carotid Artery, External / surgery
  • Carotid Artery, Internal / surgery
  • Cerebral Revascularization / instrumentation
  • Cerebral Revascularization / methods*
  • Cerebral Revascularization / statistics & numerical data
  • Embolization, Therapeutic / statistics & numerical data
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Endovascular Procedures / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / complications*
  • Head and Neck Neoplasms / mortality
  • Hemorrhage / etiology
  • Hemorrhage / mortality
  • Hemorrhage / surgery*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Risk Assessment / statistics & numerical data
  • Rupture, Spontaneous / etiology
  • Rupture, Spontaneous / mortality
  • Rupture, Spontaneous / surgery
  • Secondary Prevention / instrumentation
  • Secondary Prevention / methods
  • Secondary Prevention / statistics & numerical data
  • Stents
  • Survival Rate
  • Treatment Outcome