title: Covered Stents for the Prevention and Treatment of Carotid Blowout Syndrome.
abstract: BACKGROUND
  Carotid blowout syndrome (CBS) is a life-threatening emergency resulting from compromise of the carotid artery caused by malignancy in the head and neck.
  
  
  OBJECTIVE
  To report our experience with covered stents for the prevention or treatment of carotid blowout syndrome secondary to head and neck cancer to ascertain the safety and efficacy of this technique.
  
  
  METHODS
  We reviewed the characteristics and outcome of all patients who underwent covered stent placement in the extracranial carotid artery in the setting of head and neck malignancy between 2006 and 2013 at the University of Miami. Patient demographics, presenting symptoms, devices used, perioperative complications, imaging, and follow-up data were reviewed.
  
  
  RESULTS
  Seventeen carotids in 15 patients, whose ages ranged from 20 to 84 years (mean, 70.4 years), were treated with 20 covered nitinol (Viabahn Endoprosthesis, Gore, Flagstaff, Arizona) stents. Three patients were treated acutely for bleeding from carotid blowout, and 12 were treated prophylactically for threatened carotid blowout. All patients were given periprocedural dual antiplatelet therapy. No thromboembolic or ischemic complications were noted. Hemorrhage after treatment occurred in 4 patients. In 2 patients, the hemorrhage was from a source not covered by the stent.
  
  
  CONCLUSIONS
  The use of covered stents is a simple, safe, and effective method for treating or preventing carotid blowout syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice.
authors: Departments of *Neurosurgery and ‡Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors: Brandon G
authors: BG
authors: Gaynor
authors: Diogo C
authors: DC
authors: Haussen
authors: Sudheer
authors: S
authors: Ambekar
authors: Eric C
authors: EC
authors: Peterson
authors: Dileep R
authors: DR
authors: Yavagal
authors: Mohamed Samy
authors: MS
authors: Elhammady
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002340:Carotid Artery Diseases / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D002533:Cerebral Angiography; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors