title: Rapid, sequential bilateral acute carotid blowout syndrome.
abstract: BACKGROUND
  This study aims to report the treatment and outcome of sequential bilateral acute carotid artery blowout syndrome.
  
  
  METHODS
  From 2004 to 2010, we treated seven male patients with sequential bilateral blowout syndrome long after irradiation treatment for head and neck cancer. After first common carotid artery (CCA)-internal carotid artery (ICA) rupture, six were treated with CCA-ICA occlusion and one with graft stenting. The contralateral ICAs were normal or stenotic on angiography in all patients. After the contralateral CCA-ICA rupture, five patients received CCA-ICA occlusion, one received graft stent treatment, and one received no treatment.
  
  
  RESULTS
  Five of the seven patients died soon after the final treatment. Two patients developed cerebral infarctions (one treated with bilateral stenting, one treated with occlusion), one died from extensive local infection, one died soon after a third treatment, one died of progression of the disease, and one refused a second treatment and died soon after the diagnostic angiography. Two patients survived with follow-up periods of 1 and 5 years. In all seven patients, the contralateral CCA-ICA blowout occurred within 3 months after the first ICA occlusion.
  
  
  CONCLUSIONS
  Bilateral ICA occlusion is an alternative management for sequential carotid artery blowout, but the mortality is high and outcome is poor. A normal angiogram cannot exclude the possibility of rapid development of a contralateral carotid artery blowout shortly after a first episode in patients who have received radiotherapy for head and neck cancer.
authors: Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Chung-Shan South Road, Taipei, Taiwan 10016. hmliu@ntu.edu.tw
authors: Hon-Man
authors: HM
authors: Liu
authors: Chung-Yi
authors: CY
authors: Yang
authors: Chung-Wei
authors: CW
authors: Lee
authors: Yao-Hung
authors: YH
authors: Wang
authors: Ya-Fang
authors: YF
authors: Chen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome
references: AJNR Am J Neuroradiol. 2006 Aug;27(7):1543-5
references: 16908577
references: J Laryngol Otol. 1989 Aug;103(8):760-4
references: 2769046
references: Am Surg. 1999 Dec;65(12):1176-9
references: 10597070
references: Br J Radiol. 2006 Mar;79(939):226-31
references: 16498035
references: Otolaryngol Head Neck Surg. 2008 Jan;138(1):86-91
references: 18164999
references: AJNR Am J Neuroradiol. 1995 Apr;16(4):749-54
references: 7611033
references: Ann Otol Rhinol Laryngol. 2010 Jul;119(7):476-84
references: 20734970
references: Eur J Radiol. 2013 Jan;82(1):95-9
references: 21310571
references: Neurocrit Care. 2005;2(2):176-8
references: 16159061
references: AJNR Am J Neuroradiol. 1999 Jun-Jul;20(6):1069-77
references: 10445446
references: AJNR Am J Neuroradiol. 1995 Aug;16(7):1453-8
references: 7484632
references: AJNR Am J Neuroradiol. 1996 May;17(5):843-52
references: 8733956
references: J Vasc Surg. 2008 May;47(5):936-45
references: 18328665
references: AJNR Am J Neuroradiol. 2003 May;24(5):975-81
references: 12748106
references: Laryngoscope. 2002 Mar;112(3):428-33
references: 12148848
references: Surg Neurol. 1998 Aug;50(2):147-55; discussion 155-6
references: 9701120
references: Curr Opin Otolaryngol Head Neck Surg. 2004 Apr;12(2):110-5
references: 15167047
references: Am J Otolaryngol. 2003 Nov-Dec;24(6):417-9
references: 14608577
references: J Neurosurg. 1987 Jan;66(1):40-6
references: 3783258