Cases Of Carotid Blowout Syndrome Research Articles

頸動脈破裂の2症例

頸動脈破裂の2症例

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

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.

Prevention and Treatment of Life-Threatening Bleeding After Thyroid Surgery.

BackgroundFew reports have discussed life-threatening bleeding that occurs postoperatively in patients who have undergone thyroid surgery. In this article, we discuss the causes, treatment measures, and possible ways of preventing this severe complication.Material/MethodsFrom Jan 2002 to Dec 2014 we retrospectively analyzed 7 patients who developed life-threatening bleeding after undergoing thyroid surgery at our center.ResultsAmong the group of 7 patients, there was 1 case of superior thyroid artery hemorrhage (STAH), 5 cases of carotid blowout syndrome (CBS), and 1 case of tracheo-innominate fistula (TIF). The STAH was caused by unreliable ligation. All the cases of CBS and TIF were caused by surgical wound infection. Six patients were transferred to the operating room immediately; open surgical treatment was performed on these 6 patients. Out of these 6 patients, 1 patient did not survive the operation, and hemorrhage was successfully controlled in 3 patients. The remaining 2 patients again experienced bleeding even after undergoing open surgery. Only 1 patient developed long-term neurological complications.ConclusionsInfection is the most common cause of life-threatening bleeding that occurs postoperatively in some patients who have undergone thyroid surgery. Early surgical intervention can save the lives of these patients without causing any severe neurological complications.

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

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.

Polytetrafluoroethylene‐covered nitinol stent graft for treatment of carotid artery blowout syndrome in head and neck cancer patients

To evaluate the efficacy, tolerance, and outcomes of covered stents in the treatment of carotid blowout syndrome (CBS) in head and neck cancer patients. Individual retrospective cohort study. We retrospectively reviewed the medical and image files of all 20 consecutive head and neck cancer patients treated with covered stent grafts for CBS. Six acute, 12 impending, and two threatened cases of CBS were treated in patients who all had previously received radiation therapy. We evaluated the feasibility, hemostatic efficacy, survival without bleeding, and complications. The etiologies of CBS were as follows: group 1, 13 carotid axis (common or internal carotid artery) pseudoaneurysms and one rupture; group 2, six patients with no identifiable source of bleeding on angiography but with a threatened carotid axis on computed tomography (CT). In all patients, a polytetrafluoroethylene-covered nitinol stent graft (Fluency; Bard/Angiomed GmbH & Co, Karlsruhe, Germany) was successfully placed. All of the stents were patent at the end of the procedure. Immediate hemostasis was achieved in the six hemorrhagic cases. Immediate transient ischemic attacks were observed in two patients, and carotid sinus syndrome was observed in one patient. Post-treatment bleeding was observed in five patients in group 2 and no patients in group 1. Survival without bleeding was 251 days in group 1 and 35 days in group 2. During follow-up, three asymptomatic stent thromboses occurred at a mean of 58 days. Covered stent placement is highly feasible and proved effective without major complications in CBS due to carotid axis bleeding.

Endovascular treatment paradigm of carotid blowout syndrome: Review of 8-years experience

ObjectivesEndovascular treatment is effective in treating carotid blowout syndrome (CBS). We reviewed our experience in addressing CBS over eight years and presented an account of the treatment paradigm and management algorithm. MethodAll cases of CBS from 2003 to 2010 with endovascular treatment performed in our center were reviewed. 15 CBS in 14 patients were recruited. Based on our management algorithm, treatment regimen was stratified into deconstructive or constructive methods. Their clinical presentations, angiographic features, angiographic and clinical outcomes were reviewed. Results10 patients were treated with deconstructive method by means of permanent vessel occlusion (PVO) and 4 patients were treated with constructive method by means of placement of covered stent (n=3) or flow diverting device (n=1). Immediate hemostasis was achieved in all cases. 7 (50%) patients, in whom 5 treated with PVO and 2 with covered stent, had favorable outcomes and survived at a median follow-up period of 4 months (range: 1–84 months). ConclusionPermanent vessel occlusion remains the gold standard of treatment and tends to show a favorable long-term outcome. Off-label use of covered stent and flow-diverting device can produce satisfactory results should balloon occlusion test fail, but long-term follow up would be required for definitive assessment.

0.035-inch Non-Detachable Fibered CoilでInternal Trappingを施行したCarotid Blowout Syndrome：症例報告

●Abstract● Objective: We report a case of carotid blowout syndrome (CBS) treated by internal trapping using 0.035-inch non-detachable fibered coils. Case presentation: A 54-year-old man presented with massive hemorrhage from a skin defect in the neck 12 years after radical neck dissection and chemoradiation therapy for a right submandibular gland adenocarcinoma. Emergency tracheostomy was performed and gauze compression resulted in hemostasis. CT angiography revealed a pseudoaneurysm of the right cervical carotid artery. In addition, the right external carotid artery was occluded. Under the diagnosis of impending CBS, we performed endovascular treatment on an emergency basis. Since the patient tolerated temporary balloon occlusion of the right common carotid artery, internal trapping using 0.035-inch non-detachable coils was performed under proximal flow control. The right carotid artery was successfully occluded without any neurological deficit. Conclusion: Internal trapping using 0.035-inch non-detachable fibered coils is an effective treatment for CBS. ●Key Words● carotid blowout syndrome, internal trapping, 0.035-inch non-detachable fibered coil