Covered Stent Treatment of Carotid Blowout Syndrome

 

 Buy Article Permissions and Reprints

ABSTRACT

Carotid artery blowout is a devastating complication of head and neck malignancy, irradiation, and trauma. New endovascular therapies of acute carotid artery rupture involve stent-directed, carotid-sparing treatment strategies. We report a case of successful covered stent treatment of carotid artery hemorrhage in the setting of head and neck cancer and review the literature describing the use of this therapeutic method. Evaluation of 19 recently reported cases of covered stent treatment of carotid artery blowout due to head and neck cancer and presenting with sentinel or acute hemorrhage demonstrates that this method is a fast and effective means of controlling bleeding, with a technical success rate of ~95%. A significant early recurrent hemorrhage rate raises concern regarding the short-term safety and efficacy of this therapy, however, and suggests that stent graft treatment of carotid artery rupture due to head and neck malignancy is best suited as a temporizing measure before more definitive therapy.

REFERENCES

• 1 Maran A G, Amin M, Wilson H A. Radical neck dissection: a 19-year experience.  J Laryngol Otol. 1989;  103 760-764
  CrossrefPubMedGoogle Scholar
• 2 Chaloupka J C, Putman C M, Citardi M J, Ross D A, Sasaki C T. Endovascular therapy of carotid blowout syndrome in head and neck surgical patients: diagnostic and managerial considerations.  AJNR Am J Neuroradiol. 1996;  17 843-852
  PubMedGoogle Scholar
• 3 Osguthorpe J D, Hungerford G D. Transarterial carotid occlusion: case report and review of the literature.  Arch Otolaryngol. 1984;  110 694-696
  PubMedGoogle Scholar
• 4 Lesley W S, Chaloupka J C, Weigele J B, Mangla S, Dogar M A. Preliminary experience with endovascular reconstruction for the management of carotid blowout syndrome.  AJNR Am J Neuroradiol. 2003;  24 975-981
  PubMedGoogle Scholar
• 5 Kwok P C, Cheung J Y, Tang K W, Wong W K. Re: Endovascular treatment of acute carotid blow-out syndrome.  J Vasc Interv Radiol. 2001;  12 895-896
  PubMedGoogle Scholar
• 6 Simental A, Johnson J T, Horowitz M. Delayed complications of endovascular stenting for carotid blowout.  Am J Otolaryngol. 2003;  24 417-419
  PubMedGoogle Scholar
• 7 Macdonald S, Gan J, McKay A J, Edwards R D. Endovascular treatment of acute carotid blow-out syndrome.  J Vasc Interv Radiol. 2000;  11 1184-1188
  CrossrefPubMedGoogle Scholar
• 8 Broomfield S J, Bruce I A, Luff D A, Birzgalis A R, Ashleigh R J. Endovascular management of the carotid blowout syndrome.  J Laryngol Otol. 2006;  120 694-697
  PubMedGoogle Scholar
• 9 Kim H S, Lee D H, Kim H J et al.. Life-threatening common carotid artery blowout: rescue treatment with a newly designed self-expanding covered nitinol stent.  Br J Radiol. 2006;  79 226-231
  CrossrefPubMedGoogle Scholar
• 10 Warren F M, Cohen J I, Nesbit G M, Barnwell S L, Wax M K, Andersen P E. Management of carotid “blowout” with endovascular stent grafts.  Laryngoscope. 2002;  112 428-433
  CrossrefPubMedGoogle Scholar
• 11 Desuter G, Hammer F, Gardiner Q et al.. Carotid stenting for impending carotid blowout: suitable supportive care for head and neck cancer patients?.  Palliat Med. 2005;  19 427-429
  CrossrefPubMedGoogle Scholar
• 12 Chang F C, Lirng J F, Tai S K, Luo C B, Teng M M, Chang C Y. Brain abscess formation: a delayed complication of carotid blowout syndrome treated by self-expandable stent-graft.  AJNR Am J Neuroradiol. 2006;  27 1543-1545
  PubMedGoogle Scholar

Ron C GabaM.D. 

Department of Radiology, University of Illinois Medical Center at Chicago

1740 West Taylor Street, MC 931, Chicago, IL 60612