Risk factors of recurrent carotid blowout syndrome and strategy of endovascular management.

BACKGROUND

Carotid blowout syndrome (CBS) is a catastrophic complication after aggressive head and neck cancer treatment. Endovascular embolization is an effective modality to manage CBS. However, some CBS may have recurrent CBS (rCBS) after endovascular management. This study aims to report the potential rCBS risk and endovascular management strategy.

METHODS

Of the 225 patients with CBS referred for embolization in 13 years, 31 men and one woman (mean age, 55 years) with 35 rCBS with pseudoaneurysms formation were identified after endovascular management. Moreover, the rCBS preembolization angioarchitecture, rCBS cause, rCBS time interval, embolic materials selection, and final embolization clinical/angiographic outcomes were retrospectively analyzed.

RESULTS

rCBS with pseudoaneurysm due to disease progression (DP) occurred in 17 patients, while 15 patients had insufficient embolization (IE) with 18 rCBS. The mean rCBS timing interval was 76 days with 129 and 12 days due to DP or IE. The most common rCBS locations were the carotid bulb and the main trunk of the external carotid artery (n = 20, 57%), followed by internal carotid artery (n = 8, 23%), distal branch of the external carotid artery (n = 4, 11%), and common carotid artery (n = 3, 9%). Endovascular management was technically successful in all patients by reconstruction (n = 7, 20%) or destruction (n = 28, 80%) techniques. Three patients (9%) had procedure-related complications. No rCBS was observed in all affected arteries after the last embolization in a mean 11-month clinical follow-up.

CONCLUSION

rCBS may result from DP or IE. The common location of IE-related rCBS usually occurred in the carotid branches. It occurred within two weeks of CBS largely because of the underestimation of the extension of the affected carotid artery. In addition, DP is natural in head and neck cancer after aggressive treatment. Thus, endovascular management remained an effective method to manage rCBS.