Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer ‐ Related Carotid Blowout Syndrome

Autor: Wilson Wai-Shing Ho, Guo-Yan Yuan, Ping-An Wu, Zhaoqun Lu, Ji-Fu Cai, Ru-Ming Zhou, Jimmy Yu Wai Chan, Raymond K. Y. Tsang, Si-Yi Yang
Rok vydání: 2021
Předmět:
Adult
Carotid Artery Diseases
Male
medicine.medical_specialty
medicine.medical_treatment
External carotid artery
Hemodynamics
Hemorrhage
030204 cardiovascular system & hematology
Lower risk
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Recurrence
medicine.artery
Secondary Prevention
medicine
Humans
cardiovascular diseases
Embolization
Common carotid artery
Aged
Retrospective Studies
Cerebral Revascularization
Rupture
Spontaneous
business.industry
Endovascular Procedures
Head and neck cancer
Vascular bypass
Middle Aged
medicine.disease
Embolization
Therapeutic
Carotid blowout
Surgery
Survival Rate
Treatment Outcome
Otorhinolaryngology
Head and Neck Neoplasms
Carotid Artery
External
cardiovascular system
Female
Stents
business
Carotid Artery
Internal
030217 neurology & neurosurgery
Follow-Up Studies
Zdroj: The Laryngoscope. 131:1548-1556
ISSN: 1531-4995
0023-852X
DOI: 10.1002/lary.29427
Popis: OBJECTIVE/HYPOTHESIS To investigate the endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass in the management of patients with head and neck cancer-related carotid blowout syndrome (CBS). STUDY DESIGN Retrospective case series. METHODS Retrospective analysis of clinical data of patients with head and neck cancer-related CBS treated by endovascular intervention and/or EC/IC vascular bypass, analysis of its bleeding control, neurological complications, and survival results. RESULTS Thrity-seven patients were included. Twenty-five were associated with external carotid artery (ECA); twelve were associated with internal or common carotid artery (ICA/CCA). All patients with ECA hemorrhage were treated with endovascular embolization. Of the 12 patients with ICA/CCA hemorrhage, 9 underwent EC/IC bypass, 1 underwent endovascular embolization, and 3 underwent endovascular stenting. For patients with ECA-related CBS, the median survival was 6 months, and the 90-day, 1-year, and 2-year survival rates were 67.1%, 44.7%, and 33.6%, respectively; the estimated rebleeding risk at 1-month, 6-month, and 2-year was 7.1%, 20.0%, and 31.6%, respectively. For patients with ICA/CCA-related CBS, the median survival was 22.5 months, and the 90-day, 1-year, and 2-year survival rates were 92.3%, 71.8%, and 41.0%, respectively; the estimated rebleeding risk at 1 month, 6 months, and 2 years is 7.7%,15.4%, and 15.4%, respectively. ICA/CCA-related CBS patients have significantly longer survival time and lower risk of rebleeding, which may be related to the more use of EC/IC vascular bypass as a definite treatment. CONCLUSIONS For patients with ICA/CCA-related CBS, if there is more stable hemodynamics, longer expected survival, EC/IC vascular bypass is preferred. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1548-1556, 2021.
Databáze: OpenAIRE
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