OBJECTIVES/HYPOTHESIS: To evaluate the efficacy, tolerance, and outcomes of covered stents in the treatment of carotid blowout syndrome (CBS) in head and neck cancer patients. STUDY DESIGN: Individual retrospective cohort study. METHODS: We retrospectively reviewed the medical and image files of all 20 consecutive head and neck cancer patients treated with covered stent grafts for CBS. Six acute, 12 impending, and two threatened cases of CBS were treated in patients who all had previously received radiation therapy. We evaluated the feasibility, hemostatic efficacy, survival without bleeding, and complications. RESULTS: The etiologies of CBS were as follows: group 1, 13 carotid axis (common or internal carotid artery) pseudoaneurysms and one rupture; group 2, six patients with no identifiable source of bleeding on angiography but with a threatened carotid axis on computed tomography (CT). In all patients, a polytetrafluoroethylene-covered nitinol stent graft (Fluency; Bard/Angiomed GmbH & Co, Karlsruhe, Germany) was successfully placed. All of the stents were patent at the end of the procedure. Immediate hemostasis was achieved in the six hemorrhagic cases. Immediate transient ischemic attacks were observed in two patients, and carotid sinus syndrome was observed in one patient. Post-treatment bleeding was observed in five patients in group 2 and no patients in group 1. Survival without bleeding was 251 days in group 1 and 35 days in group 2. During follow-up, three asymptomatic stent thromboses occurred at a mean of 58 days. CONCLUSIONS: Covered stent placement is highly feasible and proved effective without major complications in CBS due to carotid axis bleeding.
OBJECTIVES/HYPOTHESIS: To evaluate the efficacy, tolerance, and outcomes of covered stents in the treatment of carotid blowout syndrome (CBS) in head and neck cancerpatients. STUDY DESIGN: Individual retrospective cohort study. METHODS: We retrospectively reviewed the medical and image files of all 20 consecutive head and neck cancerpatients treated with covered stent grafts for CBS. Six acute, 12 impending, and two threatened cases of CBS were treated in patients who all had previously received radiation therapy. We evaluated the feasibility, hemostatic efficacy, survival without bleeding, and complications. RESULTS: The etiologies of CBS were as follows: group 1, 13 carotid axis (common or internal carotid artery) pseudoaneurysms and one rupture; group 2, six patients with no identifiable source of bleeding on angiography but with a threatened carotid axis on computed tomography (CT). In all patients, a polytetrafluoroethylene-covered nitinol stent graft (Fluency; Bard/Angiomed GmbH & Co, Karlsruhe, Germany) was successfully placed. All of the stents were patent at the end of the procedure. Immediate hemostasis was achieved in the six hemorrhagic cases. Immediate transient ischemic attacks were observed in two patients, and carotid sinus syndrome was observed in one patient. Post-treatment bleeding was observed in five patients in group 2 and no patients in group 1. Survival without bleeding was 251 days in group 1 and 35 days in group 2. During follow-up, three asymptomatic stent thromboses occurred at a mean of 58 days. CONCLUSIONS: Covered stent placement is highly feasible and proved effective without major complications in CBS due to carotid axis bleeding.
Authors: Carlos Suárez; Verónica Fernández-Alvarez; Marc Hamoir; William M Mendenhall; Primoz Strojan; Miquel Quer; Carl E Silver; Juan P Rodrigo; Alessandra Rinaldo; Alfio Ferlito Journal: Cancer Manag Res Date: 2018-11-13 Impact factor: 3.989