Carotid blowout syndrome after nasopharyngeal carcinoma radiotherapy: successful treatment by internal carotid artery occlusion after stent implantation failure.

Fei Dong,Bin Li,Guangqiang Zhang,Jie Min,Ming Chao,Weiren Liang,Jianjun Wu,Minming Zhang,Qian Li,Kai Jin

doi:10.1186/s40064-016-3209-y

Fei Dong, Bin Li + Show 8 more

Open Access

https://doi.org/10.1186/s40064-016-3209-y

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Abstract

IntroductionCarotid blowout syndrome (CBS) secondary to radiation therapy is life-threatening and requires emergency treatment. More recently, endovascular treatment has provided an effective way to control CBS-related bleeding.Case descriptionWe present a case of CBS with a rupture of the internal carotid artery (ICA) pseudo-aneurysm after Gamma Knife radiation therapy for nasopharyngeal carcinoma (NPC). The patient was a 55-year-old man who was transferred to our hospital with severe repetitive epistaxis. He had a history of NPC and had been treated with Gamma Knife radiation therapy 7 months prior, with a central dose of 32 Gy and marginal dose of 16 Gy. As CBS was confirmed by angiography, and the affected part of the ICA lumen exhibited moderate stenosis, the patient was successfully treated by ICA occlusion after stent implantation failure. The patient died 40 months after this operation from tumor recurrence, but without epistaxis during follow up.Discussion and EvaluationQuick selection of an appropriate treatment method is very important for an acute CBS patient.ConclusionICA occlusion can be directly considered for an acute CBS patient, if the affected ICA exhibits stenosis that is moderate or above.

Highlights

Carotid blowout syndrome (CBS) secondary to radiation therapy is life-threatening and requires emergency treatment
Endovascular treatment has provided an effective way to control the bleeding associated with carotid blowout syndrome
We report a case of CBS secondary to Gamma Knife radiation therapy for nasopharyngeal carcinoma that was successfully treated by internal carotid artery (ICA) occlusion after stent implantation failure

Summary

Background

Carotid blowout syndrome (CBS) is an uncommon, lifethreatening complication in patients with radiation therapy for nasopharyngeal carcinoma (NPC) that requires emergency treatment. On admission to our hospital, physical examination showed a blood pressure of 106/78 mmHg, pulse rate of 150 beats per minute, and nasal bleeding. But massive oral and nasal bleeding emerged again 8 h later. His blood pressure dropped to 80/45 mmHg and pulse rate rose to 160 beats per minute. An emergency ICA compression test was performed, and it showed good compensatory blood flow from the Circle of Willis (Fig. 2). The patient died 40 months after this operation from tumor recurrence, but without epistaxis during follow up

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