Endovascular intervention for carotid blowout syndrome and predictors of recurrence: A retrospective and multicenter cohort study.
Publication/Presentation Date
11-1-2024
Abstract
INTRODUCTION: Carotid blowout syndrome (CBS) is a potentially life-threatening complication of head and neck cancer and associated treatment. In this study, we assess the safety and efficacy of deconstructive and reconstructive procedures with a focus on CBS recurrence.
METHODS: We conducted a multicenter retrospective analysis of a prospectively maintained database and identified 80 consecutive neurointerventions for CBS from 2016 to 2020. Patients were divided into 2 groups: deconstructive embolization (68 patients) and reconstructive stenting (12 patients). A comparative analysis was performed between the two groups.
RESULTS: The CBS recurrence rate was 23.8 % with 84.2 % of recurrences occurring within 90 days of the primary event. The median time to rebleeding was 8.0 days (IQR: 2.0 - 28.5) with a mortality rate of 26.3 %. There was no significant difference in rates of peri-operative ischemic stroke (1.5 % vs. 0 %, p=0.672) or peri-operative mortality (1.5 % vs. 0 %, p=0.670). CBS recurrence was significantly higher in the reconstructive group (58.3 % vs. 17.6 %, p=0.002). On multivariate analysis, reconstructive stenting independently predicted rebleeding (adjusted hazard ratio 8.31, 95 % CI: 2.34-29.59, p=0.001). There was no significant association between CBS recurrence and pre-operative (p=0.600) or post-operative (p=0.275) anticoagulant/antiplatelet use.
CONCLUSION: CBS remains a challenging and potentially catastrophic complication of head and neck cancers. Reconstructive procedures, including stenting, predicted CBS recurrence independent of bleeding site or tumor invasion. Postoperative surveillance based on time intervals to CBS recurrence and engineering advancements including improved vessel reconstruction devices have the potential to reduce rehemorrhage rates and improve patient outcomes. Further clinical investigations amongst larger cohorts are needed.
Volume
246
First Page
108584
Last Page
108584
ISSN
1872-6968
Published In/Presented At
Weinberg, J. H., Liu, K., Asada, A. M., Bahri, M., El Naamani, K., Zakeri, A., Zakeri, J., Tjoumakaris, S., Jabbour, P., Rocco, J. W., VanKoevering, K., Yang, S., Old, M., Powers, C., Nimjee, S., & Youssef, P. (2024). Endovascular intervention for carotid blowout syndrome and predictors of recurrence: A retrospective and multicenter cohort study. Clinical neurology and neurosurgery, 246, 108584. https://doi.org/10.1016/j.clineuro.2024.108584
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
39368393
Department(s)
Administration and Leadership
Document Type
Article