Patients with head and neck cancers and associated postirradiated carotid blowout syndrome: endovascular therapeutic methods and outcomes.
OBJECTIVE
This study retrospectively evaluated the technical and hemostatic outcomes of reconstructive and deconstructive endovascular management in patients with head and neck cancers associated with carotid blowout syndrome (CBS).


METHODS
Twenty-four patients with head and neck cancers with CBS involving the main trunk of carotid artery underwent endovascular therapy. This included reconstructive management with self-expandable stent grafts to preserve the diseased carotid artery in 11 patients and deconstructive management with balloons, coils, or acrylic adhesives to occlude the diseased carotid artery in 13 patients. Based on clinical severity and therapeutic priority, we classified CBS in our patients into two groups: acute or impending and threatened. The angiographic severity was graded from 0 to 3. Evaluation of technical outcome included technical success, initial and delayed complications, and patency of stent graft in the reconstructive group. The hemostatic outcome was evaluated by immediate hemostatic result, rebleeding, and duration of hemostasis. Sex, age, clinical and angiographic severities, local wound complications, and location of the pathologic lesion were examined as predictors of the technical and hemostatic outcomes of endovascular management by using Cox regression method.


RESULTS
Technical success and immediate hemostasis were achieved in all patients of both groups. Initial complications during the procedures were encountered in four patients (36.4%) who underwent reconstructive management and in one patient (7.7%) who underwent deconstructive management (P = .142). Delayed complications during the follow-up were seen in one patient (9.1%) with reconstructive management and one patient (7.7%) with deconstructive management (P > .99). Rebleeding occurred in five patients (45.5%) in the reconstructive management group and in three patients (23.1%) in the deconstructive management group (P = .659). The mean duration of hemostasis after initial reconstructive and deconstructive management was 4.0 +/- 8.1 and 8.5 +/- 10.1 months, respectively (P = .249). Rebleeding was noted in 7 of 11 patients (63.6%) with acute CBS and in 1 of 13 patients (7.7%) with impending and threatened CBS (P = .008).


CONCLUSIONS
There is no significant difference in technical and hemostatic outcomes between the reconstructive and deconstructive endovascular management methods. Hemostatic results were influenced by clinical severity. The rebleeding rate is higher in patients with advanced and acute clinical severity.
Chang
Feng-Chi
FC
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan. fcchang@vghtpe.gov.tw
Lirng
Jiing-Feng
JF
Luo
Chao-Bao
CB
Wang
Shuu-Jiun
SJ
Wu
Hsiu-Mei
HM
Guo
Wan-Yuo
WY
Teng
Michael Mu Huo
MM
Chang
Cheng-Yen
CY
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011859:Radiography; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D013577:Syndrome; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D014654:Vascular Patency
D014014:Tissue Adhesives