Management for Carotid Blowout Syndrome Reviewed

October 6, 2009—Athos Patsalides, MD, et al published online ahead of print in the Journal of NeuroInterventional Surgery a review of their experience in addressing carotid blowout syndrome (CBS) and an up-to-date algorithm of endovascular management.

According to the investigators, CBS is a high-risk condition associated with significant morbidity and mortality that may result from invasion and destruction of the cervical carotid vasculature from head and neck squamous cell carcinoma. Endovascular approaches offer multiple modalities for treatment to prevent morbidity and death.

As detailed by the investigators, 16 lesions were identified in eight patients treated with nine procedures during the previous year. Pseudoaneurysm and/or active extravasation were documented in at least one vessel in all eight patients presenting with acute CBS.

There were a total of 13 pseudoaneurysms: five in the external carotid artery (ECA) trunk, four in ECA branches, one in the internal carotid artery (ICA), and three in the common carotid artery (CCA). There were three additional ICA lesions caused by tumor infiltration, resulting in two ICA occlusions and one long-segment stenosis.

The investigators performed permanent vessel occlusions in 11 lesions: four in the ECA trunk, four in ECA branches, and three in the ICA. Stent grafts were placed in five lesions: three in the CCA, one in the ICA, and one in the ECA trunk.

As detailed in the Journal of NeuroInterventional Surgery, technical success and immediate hemostasis were achieved in all patients. The investigators reported no procedural deaths or immediate complications. With a median follow-up of 2 months (range, 1–13 months), three patients died: one from recurrent CBS, one from global brain ischemia after a cardiac arrest event unrelated to CBS, and one from systemic disease. There were no other recurrences of bleeding or neurological complications.

According to the investigators, endovascular techniques offer an armamentarium to effectively address CBS, significantly affecting the care and outcome in this particular oncologic population. These techniques should be offered as early as possible in the context of a multidisciplinary approach, they concluded.