title: Contemporary management of carotid blowout syndrome utilizing endovascular techniques.
abstract: To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS).
  
  
  
  Retrospective chart review.
  
  
  
  Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied.
  
  
  
  Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable.
  
  
  
  The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist.
  
  
  
  4. Laryngoscope, 2016 127:383-390, 2017.
authors.affiliation: Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
authors.forename: Nauman F
authors.initials: NF
authors.lastname: Manzoor
authors.affiliation: Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
authors.forename: Rod P
authors.initials: RP
authors.lastname: Rezaee
authors.affiliation: Department of Neuroradiology, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Ray
authors.affiliation: Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Wick
authors.affiliation: Department of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland.
authors.forename: Kristine
authors.initials: K
authors.lastname: Blackham
authors.affiliation: Department of Otolaryngology, Metro Health Medical Center, Cleveland, Ohio, U.S.A.
authors.forename: David
authors.initials: D
authors.lastname: Stepnick
authors.affiliation: Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lavertu
authors.affiliation: Ear Nose and Throat Institute, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Zender
mesh_terms: D000368:Aged; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D002342:Carotid Artery, External; D002343:Carotid Artery, Internal; D003131:Combined Modality Therapy; D000072226:Computed Tomography Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000401:mortality / Q000628:therapy; D006472:Oral Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D010039:Otorhinolaryngologic Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012307:Risk Factors; D055989:Septal Occluder Device; D015607:Stents; D013524:Surgical Flaps; D015996:Survival Rate; D014680:Veins / Q000637:transplantation
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Carotid blowout syndrome; and covered stents; carotid reconstruction; embolization; endovascular