title: Endovascular Management of Post-Irradiated Carotid Blowout Syndrome.
abstract: OBJECTIVE
  To retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS).
  
  
  METHODS
  Between 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher's exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes.
  
  
  RESULTS
  Technical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).
  
  
  CONCLUSIONS
  The outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Feng-Chi
authors.initials: FC
authors.lastname: Chang
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Chao-Bao
authors.initials: CB
authors.lastname: Luo
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Jiing-Feng
authors.initials: JF
authors.lastname: Lirng
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Chung-Jung
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Han-Jui
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Sheng-Che
authors.initials: SC
authors.lastname: Hung
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Wan-Yuo
authors.initials: WY
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D002340:Carotid Artery Diseases / Q000209:etiology / Q000628:therapy*; D002342:Carotid Artery, External / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome