Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Aug;21(4):543-7.
doi: 10.1177/1591019915590078. Epub 2015 Jun 18.

Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout

Waleed Brinjikji  1 , Harry J Cloft  2
Affiliations

Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout

Waleed Brinjikji et al. Interv Neuroradiol. 2015 Aug.

Abstract

Background and purpose: Carotid blowout is a life threatening complication of invasive head and neck cancers and their treatments. This is commonly treated with endovascular embolization and carotid stenting. Using the Nationwide Inpatient Sample, we report the immediate clinical results of patients receiving embolization and/or stenting for treatment of carotid blowout associated with head and neck cancer.

Materials and methods: Using the Nationwide Inpatient Sample from the period 2003-2011, we defined carotid blowout patients as those with head and neck malignancies receiving carotid stenting and/or endovascular embolization without open surgery. Outcomes studied included mortality, acute ischemic stroke, hemiplegia/paresis, and other post-operative neurologic complications. Outcomes for the endovascular embolization and carotid stenting group were compared.

Results: A total of 1218 patients underwent endovascular treatment for carotid blowout. Of these, 1080 patients (88.6%) underwent embolization procedures and 138 patients (11.4%) underwent carotid stenting. The mortality rate of endovascular embolization patients was similar to that of carotid stenting patients (8.0%, 95% confidence interval (CI) = 6.5%-9.7% versus 10.2%, 95% CI=6.0%-16.4%, p = 0.36). Stroke rate was similar between embolization patients and stenting patients (2.3%, 95% CI=1.6%-3.4% vs. 3.4%, 95% CI=1.3%-8.4%, p = 0.43). Hemiplegia rates were significantly higher rate in stenting patients compared with endovascular occlusion patients (3.8%, 95% CI=1.3%-8.4% vs. 1.4%, 95% CI=1.4%-2.4%, p = 0.05). The rate of post-operative neurologic complications was higher in stenting patients compared with embolization patients (6.5%, 95% CI=3.3%-12.1% vs. 1.4%, 95% CI=0.9%-2.4%, p < 0.0001).

Conclusions: Given the natural history of carotid blowout, carotid stenting and endovascular embolization are acceptable means of treating this disease. Endovascular embolization remains the most common treatment among patients with head and neck cancers with lower overall rates of post-operative neurologic complications, including hemiplegia/paresis and stroke.

Keywords: Endovascular; carotid blowout; coiling; stenting.

PubMed Disclaimer

References

    1. Chaloupka JC, et al. Endovascular therapy for the carotid blowout syndrome in head and neck surgical patients: Diagnostic and managerial considerations. ANJR Am J Neuroradiol 1996; 17: 843–852. - PMC - PubMed
    1. Kim HS, et al. Life-threatening common carotid artery blowout: rescue treatment with a newly designed self-expanding covered nitinol stent. Br J Radiol 2006; 79: 226–231. - PubMed
    1. Mazumdar A, et al. Update on endovascular management of the carotid blowout syndrome. Neuroimaging Clin N Am 2009; 19: 271–281. - PubMed
    1. McDonald MW, Moore MG, Johnstone PA. Risk of carotid blowout after reirradiation of the head and neck: A systematic review. Int J Radiat Oncol Biol Phys 2012; 82: 1083–1089. - PubMed
    1. Yamazaki H, et al. Frequency, outcome and prognostic factors of carotid blowout syndrome after hypofractionated re-irradiation of head and neck cancer using CyberKnife: A multi-institutional study. Radiother Oncol 2013; 107: 305–309. - PubMed

MeSH terms

LinkOut - more resources