E-123 covered stents for prevention and treatment of carotid blow-out syndrome

Abstract

Introduction Carotid blow-out syndrome (CBS) is a life threatening emergency resulting from compromise of the carotid artery due to malignancy in the head and neck. We report our experience with covered stents for the prevention or treatment of CBS secondary to head and neck cancer to ascertain the safety and efficacy of this technique. Methods The use of covered stents in the extracranial carotid artery in the setting of head and neck malignancy between the years 2006–2013 at the University of Miami was retrospectively reviewed. Patient demographics, presenting symptoms, devices used, perioperative complications, imaging, and follow-up data were reviewed. Results 17 carotids in 15 patients, with ages ranging from 20–84 years (mean 70.4) were treated with 20 covered nitinol (Viabahn Endoprosthesis, Gore, Flagstaff, AZ) stents. Three patients were treated acutely for bleeding from carotid blow out and 12 treated prophylactically for threatened carotid blow out. All patients were given peri-procedural dual antiplatelet therapy. No thromboembolic or ischemic complications were noted. Post-stenting hemorrhage attributable to CBS occurred in four patients and resulted in two deaths. Conclusion The use of covered stents is a simple, safe and effective method for treating or preventing carotid blow out syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice. Disclosures M. Elhammady: None. B. Gaynor: None. D. Haussen: None. S. Ambekar: None. E. Peterson: None. D. Yavagal: None.