4:18 PM Abstract No. 174 - Angiographic features and endovascular management of carotid blowout syndrome in patients with nasopharyngeal carcinoma treated with radiotherapy - a review of 12-years experience

Abstract

Purpose Our 12-years experience in the management of Carotid blowout syndrome (CBS) in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy (RT) was reviewed. Special emphasis was made on the angiographic findings and management approaches. Materials and Methods 14 patients with RT-treated NPC underwent Digital Subtraction Angiography (DSA) from 2000 to 2012 for management of CBS were retrospectively reviewed. The affected arterial segments, number and size of pseudoaneurysms were analyzed. The management approachs and clinical outcomes were also assessed. Results 16 DSAs were performed on 14 patients presented with acute CBS. Pseudoaneurysms were identified in 11 patients (79%) while 3 others (21%) showed active extravasation. CBS was more common in internal carotid artery (n=9, 64%) than external carotid artery (n=5, 36%). Petrous segment of ICA was the most commonly involved segment (n=5, 36%), followed by cervical segment of ICA (n=4, 29%) and maxillary artery (n=3, 21%). The maximum diameter of the pseudoaneurysms ranged from 2.3mm to 34.3mm (mean = 11.3mm). Permanent vessel occlusions or placements of covered stent were performed on 11 patients (79%). Majority (n=8, 73%) were treated with permanent vessel occlusion by either coils (n=5, 62%) or gelfoams (n=3, 38%). Gelfoam embolizations were performed in the terminal branches of maxillary, facial and mandibular arteries. Covered stents were placed in the remaining 3 patients (27%) and all had lesions in the petrous segment of ICA. Immediate hemostasis was achieved in all patients and no lethal complication was reported. Interval follow-up of 3 months showed no recurrence of CBS in all cases. Conservative management was adopted in 3 patients (21%) due to poor premorbid condition and occluded bilateral ICAs. All passed away within one week following initial diagnostic DSA. Conclusion Carotid blowout syndrome in patients with RT-treated NPC most commonly involved petrous segment of ICA. Pseudoaneurysms were identified in most cases of CBS. Both permanent vessel occlusions and placement of covered stents could achieve immediate hemostasis with no lethal complication in all our study subjects.