title: Endovascular treatment of carotid blowout syndrome.
abstract: BACKGROUND
  Carotid blowout syndrome (CBS) is a life-threatening complication of head and neck cancer and radiation therapy. Endovascular techniques have emerged as preferable alternatives to surgical ligation for treatment of CBS. We performed a systematic review and meta-analysis to study periprocedural complications and outcomes of CBS patients treated with coil embolization and covered stents.
  
  
  METHODS
  A comprehensive literature search identified studies that reported outcomes of endovascular treatment of CBS published from 2000 to April 2016. Outcomes included technical success, postoperative rebleeding, survival time, and perioperative complications. Meta-analyses were performed using a random-effects model.
  
  
  RESULTS
  Twenty-five noncomparative studies with 559 patients were included in the meta-analysis. Technical success rate was 100% in both coiling and covered stenting groups. Median survival time was 3 months (range, 0-96 months) for all CBS patients. Overall perioperative mortality was 11% (95% confidence interval [CI], 5%-17%). Postoperative rebleeding rate was 27% (95% CI, 19%-367%). Perioperative stroke and infection rates were 3% (95% CI, 1%-6%) and 1% (95% CI, 0%-5%), respectively. At last follow-up, 39% of patients were alive (95% CI, 29%-48%).
  
  
  CONCLUSIONS
  Coil embolization and stent grafts may both be safe treatment options for CBS with few perioperative complications and high rates of technical success, but prognosis after treatment remains poor. In general, noncomparative studies do not demonstrate differences between the two techniques with respect to periprocedural complications and patient outcomes.
authors.affiliation: Mayo Clinic School of Medicine, Rochester, Minn.
authors.forename: Kamila M
authors.initials: KM
authors.lastname: Bond
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minn. Electronic address: brinjikji.waleed@mayo.edu.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn.
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minn.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minn; Department of Neurosurgery, Mayo Clinic, Rochester, Minn.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016371:Cranial Irradiation / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D015607:Stents; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome