Endovascular treatment of carotid blowout syndrome: who and how to treat
Endovascular treatment of carotid blowout syndrome: who and how to treat
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DOI：
10.1136/jnis.2009.001131
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发表时间：
2010-03-01
影响因子：
4.8
通讯作者：
Riina, H. A.
中科院分区：
文献类型：
--
作者：
Patsalides, A.;Fraser, J. F.;Riina, H. A.
颈动脉爆裂综合征（CBS）是一种高风险的条件与显着的发病率和死亡率，可能会导致侵犯和破坏颈部颈动脉血管的头颈部鳞状细胞癌。血管内方法提供了多种治疗方式，以防止发病和死亡。在本文中，我们回顾了我们的经验，在解决CBS和提出了最新的算法血管内管理。16病变被确定在8例患者治疗9个程序在过去的一年。在所有8例急性CBS病例中，至少有一条血管记录到假性动脉瘤和/或活动性外渗。假性动脉瘤13个，其中颈外动脉主干5个，颈外动脉分支4个，颈内动脉1个，颈总动脉3个。3例伊卡病变因肿瘤浸润导致伊卡闭塞（2例）和长段狭窄（1例），11例ECA主干（4例）、ECA分支（4例）和伊卡（3例）病变行永久性血管闭塞。在CCA（3）、伊卡（1）和ECA主干（1）的5处病变中置入覆膜支架。所有患者均获得了技术成功和即时止血。无手术死亡或即刻并发症。中位随访2个月（范围1-13个月），3例患者死亡：1例死于复发性CBS，1例死于与CBS无关的心脏骤停事件后的全脑缺血，1例死于全身性疾病。没有其他出血或神经系统并发症复发。血管内技术提供了一种有效解决CBS的方法，显著影响了这一特定肿瘤人群的护理和结局。这些技术应尽早在多学科方法的范围内提供。
Carotid blowout syndrome (CBS) is a high-risk condition associated with significant morbidity and mortality that may result from invasion and destruction of the cervical carotid vasculature from head and neck squamous cell carcinoma. Endovascular approaches offer multiple modalities for treatment to prevent morbidity and death. In this paper we review our experience in addressing CBS and present an up-to-date algorithm of endovascular management.16 lesions were identified in 8 patients treated with 9 procedures over the past year. Pseudoaneurysm and/or active extravasation were documented in at least one vessel in all 8 cases presenting with acute CBS. There were 13 pseudoaneurysms in external carotid artery (ECA) trunk (5), ECA branches (4), internal carotid artery (ICA) (1) and common carotid artery (CCA) (3). There were 3 additional ICA lesions due to tumor infiltration, resulting in ICA occlusion (2) and long segment stenosis (1).Permanent vessel occlusion was performed in 11 lesions of the ECA trunk (4), ECA branches (4) and ICA (3). Stent-grafts were placed in 5 lesions in the CCA (3), ICA (1) and ECA trunk (1). Technical success and immediate hemostasis were achieved in all patients. There were no procedural deaths or immediate complications. With a median follow-up of 2 months (range, 1-13 months), three patients died: one from recurrent CBS, one from global brain ischemia after a cardiac arrest event unrelated to CBS and one from systemic disease. There was no other recurrence of bleeding or neurological complication.Endovascular techniques offer an armamentarium to effectively address CBS, significantly affecting the care and outcome in this particular oncologic population. These techniques should be offered as early as possible in the context of a multidisciplinary approach.