Comparison of prophylactic endovascular treatments for threatened or impending internal/common carotid artery blowout syndrome

BACKGROUND AND PURPOSE: The outcomes of prophylactic endovascular interventions for patients facing threatened or impending carotid blowout syndrome (CBS) involving the internal/common carotid artery (ICA/CCA) have not been extensively elucidated. We aimed to delineate the specific treatment outcomes for this group of patients.

MATERIALS AND METHODS: We retrospectively enrolled 109 patients with threatened or impending CBS of the ICA/CCA between 2006 and 2023. Patients were categorized into Group 1 (no intervention for ICA/CCA, n=43), Group 2 (ICA/CCA embolization, n=36), or Group 3 (ICA/CCA stenting, n=30). ANOVA and Cox regression analyses were employed to evaluate basic characteristics and the rates of recurrent bleeding, overall survival, and major complications.

RESULTS: Age (56.8 ± 8.7 vs. 54.3 ± 11.6 vs. 56.6 ± 9.2), male sex (39/43 vs. 33/36 vs. 26/30), tumor size, and type of blowout were similar (P>0.05) among groups. Tumor location (P<0.001) and presence of air-containing necrosis on CT/MRI before trans-arterial embolization (P=0.001) varied between groups. Cox regression analysis adjusted for age and sex revealed Group 2 had a lower risk of recurrent bleeding than Group 1 (adjusted hazard ratio (HR), 0.22; 95% CI, 0.10–0.47; P<0.001) and Group 3 (0.41; 95% CI, 0.170.96; P=0.042), but a higher risk of acute stroke (P=0.016). Group 2 had higher overall survival than Groups 1 and 3 (0.55; 95% CI, 0.31–0.96; P=0.036).

CONCLUSIONS: In threatened or impending CBS of the ICA/CCA, prophylactic embolization was associated with a lower risk of recurrent bleeding but a higher risk of acute stroke compared to ICA/CCA stenting or no intervention.

ABBREVIATIONS: BTO = balloon test occlusion; CBS = carotid blowout syndrome; CCA = common carotid artery; ECA = external carotid artery; HR = hazard ratio; ICA = internal carotid artery; TAE = trans-arterial embolization.