Contemporary Management of Carotid Blowout Syndrome Utilizing Endovascular Techniques
Contemporary Management of Carotid Blowout Syndrome Utilizing Endovascular Techniques
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DOI：
10.1002/lary.26144
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发表时间：
2017-02-01
期刊：
影响因子：
2.6
通讯作者：
Zender, Chad A.
中科院分区：
文献类型：
--
作者：
Manzoor, Nauman F.;Rezaee, Rod P.;Zender, Chad A.
目的/假设：为了说明复杂的跨学科决策和现代血管内技术在颈动脉爆裂综合征（CBS）患者的管理中的实用性，研究设计：回顾性图表review.Methods：包括接受血管内策略和/或手术方式治疗的患者。控制出血，神经，和生存outcomes.Results：在2004年和2014年之间，33例患者有38出血事件与头颈部癌，血管内手段管理。其中，23起事件位于颈外动脉（ECA）分支，5起事件位于ECA主干; 9起事件与颈总动脉（CCA）或颈内动脉（伊卡）相关，1起事件与无名动脉相关。7例与CCA/伊卡或无名动脉相关的事件通过血管内处死进行管理，而3例病例通过血流保留方法（覆膜支架）进行管理。只有一名患者出现永久性偏瘫。在使用血流保留方法的3例病例中，有2例覆膜支架最终通过覆盖的软组织缺损暴露，采用颈动脉血运重建或切除术进行明确治疗，以防止进一步出血。在软组织坏死的情况下，血管化的组织被用来覆盖大vessels as applicable.Conclusions：使用现代血管内方法管理急性CBS产生最佳的结果，并应采用协调的方式由头部和颈部外科医生和神经介入。
Objectives/Hypothesis: To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS).Study Designs: Retrospective chart review.Methods: Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied.Results: Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable.Conclusions: The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist.