title: Evaluation of the outcomes of endovascular management for patients with head and neck cancers and associated carotid blowout syndrome of the external carotid artery.
abstract: OBJECTIVE
  To evaluate factors related to the technical and haemostatic outcomes of endovascular management in patients with head and neck cancers (HNC) associated with carotid blowout syndrome (CBS) of the external carotid artery (ECA).
  
  
  METHODS
  Between 2002 and 2011, 34 patients with HNC with CBS involving branches of the ECA underwent endovascular therapy. Treatment included embolization with microparticles, microcoils, or acrylic adhesives. Fisher's exact test was used to examine demographic features, clinical and angiographic severities, and clinical and imaging findings as predictors of endovascular management outcomes.
  
  
  RESULTS
  Technical success and immediate haemostasis were achieved in all patients. Technical complications were encountered in one patient (2.9%). Rebleeding occurred in nine patients (26.5%). Angiographic vascular disruption grading from slight (1) to severe (4) revealed that the 18 patients with acute CBS had scores of 2 (2/18, 11.1%), 3 (3/18, 16.7%), and 4 (13/18, 72.2%). The 16 patients with impending and threatened CBS had scores of 1 (1/16, 6.25%), 2 (5/16, 31.25%), and 3 (10/16, 62.5%; p = 0.0003). For the 25 patients who underwent preprocedural computed tomography (CT)/magnetic resonance imaging (MRI) examinations within 3 months of treatment, the agreement between clinical and imaging findings reached the sensitivity, specificity, and kappa values for recurrent tumours (1, 0.7143, 0.7826), soft-tissue defect (0.9091, 0.3333, 0.2424), and sinus tract/fistula (0.4737, 0, 0.4286).
  
  
  CONCLUSIONS
  Endovascular management for patients with CBS of the ECA had high technical success and safety but was associated with high rebleeding rates. We suggest applying aggressive post-procedural follow-up and using preprocedural CT/MRI to enhance the periprocedural diagnosis.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang Ming University, School of Medicine, Taipei, Taiwan, ROC. Electronic address: fcchang374@gmail.com.
authors.forename: F-C
authors.initials: FC
authors.lastname: Chang
authors.forename: C-B
authors.initials: CB
authors.lastname: Luo
authors.forename: J-F
authors.initials: JF
authors.lastname: Lirng
authors.forename: C-J
authors.initials: CJ
authors.lastname: Lin
authors.forename: H-M
authors.initials: HM
authors.lastname: Wu
authors.forename: S-C
authors.initials: SC
authors.lastname: Hung
authors.forename: W-Y
authors.initials: WY
authors.lastname: Guo
authors.forename: M M H
authors.initials: MM
authors.lastname: Teng
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications* / Q000628:therapy*; D002342:Carotid Artery, External / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000150:complications / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media