title: Carotid blowout syndrome after nasopharyngeal carcinoma radiotherapy: successful treatment by internal carotid artery occlusion after stent implantation failure.
abstract: BACKGROUND
  Carotid blowout syndrome (CBS) secondary to radiation therapy is life-threatening and requires emergency treatment. More recently, endovascular treatment has provided an effective way to control CBS-related bleeding.
  
  
  METHODS
  We present a case of CBS with a rupture of the internal carotid artery (ICA) pseudo-aneurysm after Gamma Knife radiation therapy for nasopharyngeal carcinoma (NPC). The patient was a 55-year-old man who was transferred to our hospital with severe repetitive epistaxis. He had a history of NPC and had been treated with Gamma Knife radiation therapy 7 months prior, with a central dose of 32 Gy and marginal dose of 16 Gy. As CBS was confirmed by angiography, and the affected part of the ICA lumen exhibited moderate stenosis, the patient was successfully treated by ICA occlusion after stent implantation failure. The patient died 40 months after this operation from tumor recurrence, but without epistaxis during follow up.
  
  
  RESULTS
  Quick selection of an appropriate treatment method is very important for an acute CBS patient.
  
  
  CONCLUSIONS
  ICA occlusion can be directly considered for an acute CBS patient, if the affected ICA exhibits stenosis that is moderate or above.
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: Fei
authors.initials: F
authors.lastname: Dong
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: JianJun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: MinMing
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: GuangQiang
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: Kai
authors.initials: K
authors.lastname: Jin
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: Jie
authors.initials: J
authors.lastname: Min
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: WeiRen
authors.initials: W
authors.lastname: Liang
authors.affiliation: Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
authors.forename: Ming
authors.initials: M
authors.lastname: Chao
keywords: Carotid blowout syndrome; Endovascular treatment; Internal carotid artery; Radiotherapy