Complications of Carotid Blowout Syndrome in Patients with Head and Neck Cancers Treated by Covered Stents

The purpose of this study was to improve clinical assessment of carotid-blowout syndrome (CBS) in patients with head-and-neck cancers and with covered stents by evaluating immediate and delayed complications of reconstructive management. Eleven such patients were treated with self-expandable covered stents. We evaluated immediate and delayed complications by assessing clinical and imaging findings. Technical success and immediate hemostasis were achieved in all patients. Immediate complications were noted in four patients (36.4%), including thromboembolism in three patients and, in one patient, dissection of the carotid artery and type III endoleak by the overlapped self-expandable stent causing rebleeding. Delayed complications were noted in eight patients (72.7%), including six episodes of rebleeding in five patients, distal marginal stenosis in five patients, and delayed carotid thrombosis in three patients (one with brain abscess formation). We suggest close follow-up of the patients and aggressive re-intervention of their complications to improve outcomes.

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Evaluation of the outcomes of endovascular management for patients with head and neck cancers and associated carotid blowout syndrome of the external carotid artery

Clinical Radiology ◽

10.1016/j.crad.2013.02.015 ◽

2013 ◽

Vol 68 (11) ◽

pp. e561-e569 ◽

Cited By ~ 12

Author(s):

F.-C. Chang ◽

C.-B. Luo ◽

J.-F. Lirng ◽

C.-J. Lin ◽

H.-M. Wu ◽

...

Keyword(s):

Carotid Artery ◽

Head And Neck ◽

External Carotid Artery ◽

Head And Neck Cancers ◽

External Carotid ◽

Endovascular Management ◽

Carotid Blowout Syndrome

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Covered Stents for the Prevention and Treatment of Carotid Blowout Syndrome

Neurosurgery ◽

10.1227/neu.0000000000000738 ◽

2015 ◽

Vol 77 (2) ◽

pp. 164-167 ◽

Cited By ~ 11

Author(s):

Brandon G. Gaynor ◽

Diogo C. Haussen ◽

Sudheer Ambekar ◽

Eric C. Peterson ◽

Dileep R. Yavagal ◽

...

Keyword(s):

Carotid Artery ◽

Head And Neck ◽

Perioperative Complications ◽

Covered Stent ◽

Covered Stents ◽

Head And Neck Malignancy ◽

Presenting Symptoms ◽

Carotid Blowout Syndrome ◽

Neck Malignancy ◽

Ischemic Complications

Abstract BACKGROUND: Carotid blowout syndrome (CBS) is a life-threatening emergency resulting from compromise of the carotid artery caused by malignancy in the head and neck. OBJECTIVE: To report our experience with covered stents for the prevention or treatment of carotid blowout syndrome secondary to head and neck cancer to ascertain the safety and efficacy of this technique. METHODS: We reviewed the characteristics and outcome of all patients who underwent covered stent placement in the extracranial carotid artery in the setting of head and neck malignancy between 2006 and 2013 at the University of Miami. Patient demographics, presenting symptoms, devices used, perioperative complications, imaging, and follow-up data were reviewed. RESULTS: Seventeen carotids in 15 patients, whose ages ranged from 20 to 84 years (mean, 70.4 years), were treated with 20 covered nitinol (Viabahn Endoprosthesis, Gore, Flagstaff, Arizona) stents. Three patients were treated acutely for bleeding from carotid blowout, and 12 were treated prophylactically for threatened carotid blowout. All patients were given periprocedural dual antiplatelet therapy. No thromboembolic or ischemic complications were noted. Hemorrhage after treatment occurred in 4 patients. In 2 patients, the hemorrhage was from a source not covered by the stent. CONCLUSION: The use of covered stents is a simple, safe, and effective method for treating or preventing carotid blowout syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice.

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Management of Cutaneously Exposed Carotid Stents in Recurrent and Unresectable Head and Neck Cancer

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1716692 ◽

2020 ◽

Author(s):

André Beer-Furlan ◽

Ashley Heilingoetter ◽

Christopher Rayle ◽

Thomas O'Toole ◽

Thomas J. Nielsen ◽

...

Keyword(s):

Head And Neck Cancer ◽

Carotid Artery ◽

Head And Neck ◽

Neck Cancer ◽

Covered Stents ◽

Treatment History ◽

Small Series ◽

Life Threatening ◽

Delayed Complications ◽

Adequate Coverage

Abstract Objective Carotid blowout syndrome (CBS) is a rare but potentially life-threatening complication of head and neck cancer (HNC) treatment. Patients with CBS are managed with covered stents, limited published information exists regarding the management of delayed complications, specifically cutaneous exposure of stents. Here, we present our experience managing cutaneously exposed carotid artery stents (CAS) in patients with recurrent and unresectable HNC. Methods A single-institution retrospective analysis was performed to identify recurrent HNC patients who underwent CAS placement for CBS and complicated with cutaneous exposure of the stent between 2014 and 2016. Medical records were reviewed with attention to treatment history, pre-, intra-, and postoperative courses, anticoagulation needs, and durability of the reconstruction. Results We identified three patients who presented with a right CAS fully exposed in a large, ulcerative wound. All patients underwent a right pectoralis major myocutaneous flap (PMMF) to cover the exposed stent within 30 days of presentation to our institution. Two of three patients attained adequate coverage of the stent for more than 30 days, while one experienced partial flap dehiscence within 12 days. Two patients developed postoperative chest hematomas, which were managed conservatively. Two of three patients were able to undergo further palliative adjuvant treatments within 60 days of the initial surgical procedure. Conclusion In this small series, durable coverage of an exposed carotid artery with PMMF was successful in two of three patients with extensive disease burden and complex prior treatment history. No mortalities occurred within 30 days postoperatively.

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Predictive factors for bleeding carotid artery pseudoaneurysms in patients with previous radiations for head and neck cancers

ANZ Journal of Surgery ◽

10.1111/ans.17288 ◽

2021 ◽

Author(s):

Zhexi He ◽

Tin Fong James Zhuang ◽

Yuen Ting Rebecca Ng ◽

Horace Cheng ◽

Macy Tong ◽

...

Keyword(s):

Carotid Artery ◽

Head And Neck ◽

Predictive Factors ◽

Head And Neck Cancers

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Carotid blowout syndrome (CBS) in head and neck squamous cell carcinoma: Chemoradiation and local recurrence as inductor for carotid artery blowout?

10.1055/s-0039-1686007 ◽

2019 ◽

Author(s):

C Jacobi ◽

C Gahleitner ◽

H Bier ◽

A Knopf

Keyword(s):

Squamous Cell Carcinoma ◽

Local Recurrence ◽

Carotid Artery ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

Carotid Blowout Syndrome

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Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center

Frontiers in Neurology ◽

10.3389/fneur.2020.604672 ◽

2020 ◽

Vol 11 ◽

Author(s):

Chao Wang ◽

Peng Zhao ◽

Tao Sun ◽

Mengtao Han ◽

Yunyan Wang ◽

...

Keyword(s):

Carotid Artery ◽

Medical Records ◽

Endovascular Intervention ◽

Hybrid Technique ◽

Technical Success ◽

Presenting Symptoms ◽

Stent Restenosis ◽

V1 Segment ◽

In Stent Restenosis

Background : The hybrid recanalization of internal carotid artery (ICA) and vertebral artery (VA) in-stent restenosis or occlusion using a combination of endarterectomy and endovascular intervention has achieved technical success. We present our surgical experiences to further evaluate the safety and efficacy of the hybrid technique for the treatment of in-stent restenosis and occlusion.Methods : A cohort of 12 refractory patients with in-stent restenosis or occlusion who underwent hybrid recanalization, a combination of endarterectomy and endovascular intervention, were retrospectively analyzed. Medical records, including presenting symptoms, comorbidities, contralateral ICA/VA findings, use of antiplatelet drugs, postoperative complications, and angiographic outcomes, were collected.Results : Among 415 consecutive patients with ICA, common carotid artery, and V1 segment lesions, 12 refractory patients (2.89%) with 13 cases were enrolled in our study (1 female and 11 male). All patients underwent successful hybrid recanalization. There were no cases of postoperative stroke or death. Only two patients sustained hoarseness, but it resolved within 2 weeks after surgery. Three patients were treated with dual antiplatelet (aspirin and clopidogrel), seven with single antiplatelet (aspirin), one with single antiplatelet (clopidogrel), and one with single antiplatelet (ticagrelor). All patients were followed up in the outpatient department according to the protocol, with a mean follow-up period of 13 months (range, 6–24 months). No death or recurrent symptoms occurred during the regular follow-up period.Conclusion : The hybrid technique maybe a safe and feasible treatment option to recanalize in-stent restenosis or occlusion with acceptable complications.

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Fatal carotid blowout syndrome after BNCT for head and neck cancers

Applied Radiation and Isotopes ◽

10.1016/j.apradiso.2015.08.007 ◽

2015 ◽

Vol 106 ◽

pp. 202-206 ◽

Cited By ~ 2

Author(s):

T. Aihara ◽

J. Hiratsuka ◽

H. Ishikawa ◽

H. Kumada ◽

K. Ohnishi ◽

...

Keyword(s):

Head And Neck ◽

Head And Neck Cancers ◽

Carotid Blowout Syndrome

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Moving palliative care upstream for patients diagnosed with head and neck cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.227 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 227-227

Author(s):

Tamara M Day

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Head And Neck ◽

Symptom Burden ◽

Psychosocial Distress ◽

Head And Neck Cancers ◽

Improve Quality ◽

Convenience Sample

227 Background: Adults with cancer face complex treatment choices and symptom burden that impact their quality of life. Goals of palliative care (PC) are to reduce symptom burden and improve quality of life. Strong evidence exists that PC helps reduce symptom burden, decreases hospital utilization, and improve quality of life. Yet, PC remains underutilized, especially in the context of cancer care. Methods: This descriptive longitudinal study evaluated whether use of a psychosocial distress screening tool would help identify patients eligible for PC. A convenience sample of adults with diagnosis of head and neck cancers presenting to an otolaryngology clinic, located in the cancer center of a Midwestern academic health system, were screened for eligibility for PC referral. If eligible, the provider was notified and introduced PC to the patient. Upon acceptance, a PC referral was ordered. The project consisted of baseline (n = 61) and follow-up chart reviews (n = 60) of patients seen in clinic during over a 3-month period. Results: We found an increase in PC referrals from 14.6% at baseline to 30.8% in follow-up, a 227% increase. Psychosocial distress screenings increased from 5% at baseline to 45% in follow-up, an increase of 200%. Of patients who received a PC referral, 85.6% accepted. There were statistically significant differences found between the pre- and post-intervention groups for marital status, χ2 (3) = 9.67, ( p = .02); and cancer stage χ2 (4) = 21.35, ( p = .00) with increased referrals for married patients at higher cancer stages in the prospective group. Conclusions: This study has shown physicians maybe more likely to offer PC referrals based on cancer stages, and not based on psychosocial distress symptoms. Potential barriers to early referral to PC were identified and could serve as useful information for future studies.

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The Nellix™ EndoVascular sealing system in patients with abdominal aortic aneurysms in conjunction with iliac artery occlusive disease

Vascular ◽

10.1177/1708538116666690 ◽

2016 ◽

Vol 25 (2) ◽

pp. 190-195 ◽

Cited By ~ 1

Author(s):

Steven MM van Sterkenburg ◽

Leo H van den Ham ◽

Luuk Smeets ◽

Jan-Willem Lardenoije ◽

Michel MPJ Reijnen

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Iliac Artery ◽

Occlusive Disease ◽

Aortic Aneurysms ◽

Covered Stents ◽

Single Center ◽

Technical Success ◽

Abdominal Aortic

Introduction Concomitant abdominal aortic aneurysm formation and aortoiliac occlusive disease is a challenging combination, often requiring open reconstructive surgery. In this study, we have assessed a single center experience of the Nellix EndoVascular Aneurysm Sealing System in the treatment of an abdominal aortic aneurysm in conjunction with iliac artery occlusive disease. Methods Retrospectively case files of patients treated with Nellix EndoVascular Aneurysm Sealing System in a single center were reviewed. The primary endpoints of the study were the technical success of Nellix EndoVascular Aneurysm Sealing System in patients with coincidental iliac artery occlusive disease and the successful exclusion of the aneurysm during follow-up. Results Of the 96 patients that were treated with Nellix EndoVascular Aneurysm Sealing System, five were identified that had an abdominal aortic aneurysm in conjunction with iliac artery occlusive disease. Treated patients had either unilateral (n = 4) or bilateral (n = 1) common iliac artery occlusive disease varying from 70% stenosis to complete occlusions. The lesion length varied from 5 to 50 mm and in two cases it involved an occluded bare metal stent. The indication for surgery was the abdominal aortic aneurysm in all patients, including three also suffering from claudication. In all patients the iliac artery occlusive disease was pretreated with balloon-expandable covered stents. Technical success was achieved in all five patients. After a median follow-up of nine months all stents were patent with no signs of endoleak and stable aneurysm diameters. All patients were free of intermittent claudication or ischemic wounds. Conclusion Nellix EndoVascular Aneurysm Sealing System seems feasible and safe in patients with a combination of abdominal aortic aneurysm and iliac artery occlusive disease.

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