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Article: Comparison of treatment modalities in postirradiation carotid blowout syndrome: a multicenter retrospective review

TitleComparison of treatment modalities in postirradiation carotid blowout syndrome: a multicenter retrospective review
Authors
KeywordsCarotid blowout
Embolization
Flow diversion
Issue Date2021
PublisherElsevier Inc. The Journal's web site is located at http://www.worldneurosurgery.org/
Citation
World Neurosurgery, 2021, v. 152, p. e666-e672 How to Cite?
AbstractBackground: Carotid blowout syndrome (CBS) is not uncommon in our locality, where head and neck cancers, especially nasopharyngeal carcinoma, are prevalent. Traditionally, CBS has resulted in high morbidity and mortality. The treatment paradigm has evolved from open surgery to endovascular interventions, and each treatment modality has its merits and drawbacks. In the present study, we investigated the outcomes of different treatment modalities for postirradiation CBS. Methods: We performed a 10-year multicenter retrospective review of the outcomes after endovascular trapping, flow diverters, and bypass surgery from 2009 to 2019. Results: A total of 53 patients with 60 blowouts were included in the present study. Of the 60 blowout cases, 25 were in the flow diverter group, 27 in the endovascular trapping group, and 8 in the bypass group. The mean survival was 32.2 months, with patient age affecting overall survival (P = 0.002). The stroke rate affected the 3- and 6-month functional outcomes (odds ratio, 7.388 and 6.353; P = 0.008 and P = 0.014, respectively). Of the 24 cases in the flow diverter group, 96% had achieved immediate hemostasis, with a rebleeding rate of 20% (P = 0.009). No rebleeding had occurred with endovascular trapping or bypass. The stroke rate in the endovascular trapping, flow diverter, and bypass groups was 25.9%, 20%, and 12.5%, respectively (P = 0.696). Conclusions: Our results have shown that endovascular trapping is the first-line treatment of CBS. For patients with contraindications to endovascular trapping, the flow diverter is an alternative. For patients who have undergone flow diversion alone, definitive treatment such as bypass surgery might be indicated for selected patients to minimize the risk of rebleeding. After endovascular trapping, surgical bypass might be considered for selected patients with a higher risk of stroke.
Persistent Identifierhttp://hdl.handle.net/10722/300958
ISSN
2023 Impact Factor: 1.9
2023 SCImago Journal Rankings: 0.654
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorYuen, PT-
dc.contributor.authorChu, SL-
dc.contributor.authorTsang, CO-
dc.contributor.authorFok, KF-
dc.contributor.authorLam, SK-
dc.date.accessioned2021-07-06T03:12:36Z-
dc.date.available2021-07-06T03:12:36Z-
dc.date.issued2021-
dc.identifier.citationWorld Neurosurgery, 2021, v. 152, p. e666-e672-
dc.identifier.issn1878-8750-
dc.identifier.urihttp://hdl.handle.net/10722/300958-
dc.description.abstractBackground: Carotid blowout syndrome (CBS) is not uncommon in our locality, where head and neck cancers, especially nasopharyngeal carcinoma, are prevalent. Traditionally, CBS has resulted in high morbidity and mortality. The treatment paradigm has evolved from open surgery to endovascular interventions, and each treatment modality has its merits and drawbacks. In the present study, we investigated the outcomes of different treatment modalities for postirradiation CBS. Methods: We performed a 10-year multicenter retrospective review of the outcomes after endovascular trapping, flow diverters, and bypass surgery from 2009 to 2019. Results: A total of 53 patients with 60 blowouts were included in the present study. Of the 60 blowout cases, 25 were in the flow diverter group, 27 in the endovascular trapping group, and 8 in the bypass group. The mean survival was 32.2 months, with patient age affecting overall survival (P = 0.002). The stroke rate affected the 3- and 6-month functional outcomes (odds ratio, 7.388 and 6.353; P = 0.008 and P = 0.014, respectively). Of the 24 cases in the flow diverter group, 96% had achieved immediate hemostasis, with a rebleeding rate of 20% (P = 0.009). No rebleeding had occurred with endovascular trapping or bypass. The stroke rate in the endovascular trapping, flow diverter, and bypass groups was 25.9%, 20%, and 12.5%, respectively (P = 0.696). Conclusions: Our results have shown that endovascular trapping is the first-line treatment of CBS. For patients with contraindications to endovascular trapping, the flow diverter is an alternative. For patients who have undergone flow diversion alone, definitive treatment such as bypass surgery might be indicated for selected patients to minimize the risk of rebleeding. After endovascular trapping, surgical bypass might be considered for selected patients with a higher risk of stroke.-
dc.languageeng-
dc.publisherElsevier Inc. The Journal's web site is located at http://www.worldneurosurgery.org/-
dc.relation.ispartofWorld Neurosurgery-
dc.subjectCarotid blowout-
dc.subjectEmbolization-
dc.subjectFlow diversion-
dc.titleComparison of treatment modalities in postirradiation carotid blowout syndrome: a multicenter retrospective review-
dc.typeArticle-
dc.identifier.emailTsang, CO: acotsang@hku.hk-
dc.identifier.authorityTsang, CO=rp01519-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.wneu.2021.06.032-
dc.identifier.pmid34129983-
dc.identifier.scopuseid_2-s2.0-85108973326-
dc.identifier.hkuros323201-
dc.identifier.volume152-
dc.identifier.spagee666-
dc.identifier.epagee672-
dc.identifier.isiWOS:000679917700014-
dc.publisher.placeUnited States-

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