Kamila M Bond1, Waleed Brinjikji2, Mohammed H Murad3, Harry J Cloft4, Giuseppe Lanzino5. 1. Mayo Clinic School of Medicine, Rochester, Minn. 2. Department of Radiology, Mayo Clinic, Rochester, Minn. Electronic address: brinjikji.waleed@mayo.edu. 3. Department of Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn. 4. Department of Radiology, Mayo Clinic, Rochester, Minn. 5. Department of Radiology, Mayo Clinic, Rochester, Minn; Department of Neurosurgery, Mayo Clinic, Rochester, Minn.
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.
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 CBSpatients 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 CBSpatients. 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: 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
Authors: Alexandra T Cocca; Brittany E Levy; Jennifer T Castle; Wesley S Wilt; Mark D Fleming; Alexandra E Kejner; Rony K Aouad; Samuel C Tyagi Journal: J Vasc Surg Cases Innov Tech Date: 2022-08-28