Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer ‐ Related Carotid Blowout Syndrome. (11th February 2021)

• Record Type: Journal Article
• Authors: Wu, Ping‐An; Yuan, Guo‐Yan; Zhou, Ru‐Ming; Ho, Wilson Wai‐Shing; Lu, Zhao‐Qun; Cai, Ji‐Fu; Yang, Si‐Yi; Tsang, Raymond King‐Yin; Chan, Jimmy Yu‐Wai
• Is Part Of: Laryngoscope. Volume 131:Number 7(2021)
• Page Start: 1548
• Page End: 1556
• Publication Date: 2021-02-11
• Subjects: Carotid blowout syndrome -- endovascular -- embolization -- covered stent -- vascular bypass; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.29427
• Languages: English
• ISSNs: 0023-852X

Abstract

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