Covered Stent Treatment of Carotid Blowout Syndrome

ABSTRACT

Carotid artery blowout is a devastating complication of head and neck malignancy, irradiation, and trauma. New endovascular therapies of acute carotid artery rupture involve stent-directed, carotid-sparing treatment strategies. We report a case of successful covered stent treatment of carotid artery hemorrhage in the setting of head and neck cancer and review the literature describing the use of this therapeutic method. Evaluation of 19 recently reported cases of covered stent treatment of carotid artery blowout due to head and neck cancer and presenting with sentinel or acute hemorrhage demonstrates that this method is a fast and effective means of controlling bleeding, with a technical success rate of ~95%. A significant early recurrent hemorrhage rate raises concern regarding the short-term safety and efficacy of this therapy, however, and suggests that stent graft treatment of carotid artery rupture due to head and neck malignancy is best suited as a temporizing measure before more definitive therapy.

Carotid artery - blowout - stent

REFERENCES

• 1 Maran A G, Amin M, Wilson H A. Radical neck dissection: a 19-year experience.  J Laryngol Otol. 1989;  103 760-764
• 2 Chaloupka J C, Putman C M, Citardi M J, Ross D A, Sasaki C T. Endovascular therapy of carotid blowout syndrome in head and neck surgical patients: diagnostic and managerial considerations.  AJNR Am J Neuroradiol. 1996;  17 843-852
• 3 Osguthorpe J D, Hungerford G D. Transarterial carotid occlusion: case report and review of the literature.  Arch Otolaryngol. 1984;  110 694-696
• 4 Lesley W S, Chaloupka J C, Weigele J B, Mangla S, Dogar M A. Preliminary experience with endovascular reconstruction for the management of carotid blowout syndrome.  AJNR Am J Neuroradiol. 2003;  24 975-981
• 5 Kwok P C, Cheung J Y, Tang K W, Wong W K. Re: Endovascular treatment of acute carotid blow-out syndrome.  J Vasc Interv Radiol. 2001;  12 895-896
• 6 Simental A, Johnson J T, Horowitz M. Delayed complications of endovascular stenting for carotid blowout.  Am J Otolaryngol. 2003;  24 417-419
• 7 Macdonald S, Gan J, McKay A J, Edwards R D. Endovascular treatment of acute carotid blow-out syndrome.  J Vasc Interv Radiol. 2000;  11 1184-1188
• 8 Broomfield S J, Bruce I A, Luff D A, Birzgalis A R, Ashleigh R J. Endovascular management of the carotid blowout syndrome.  J Laryngol Otol. 2006;  120 694-697
• 9 Kim H S, Lee D H, Kim H J 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
• 10 Warren F M, Cohen J I, Nesbit G M, Barnwell S L, Wax M K, Andersen P E. Management of carotid “blowout” with endovascular stent grafts.  Laryngoscope. 2002;  112 428-433
• 11 Desuter G, Hammer F, Gardiner Q et al.. Carotid stenting for impending carotid blowout: suitable supportive care for head and neck cancer patients?.  Palliat Med. 2005;  19 427-429
• 12 Chang F C, Lirng J F, Tai S K, Luo C B, Teng M M, Chang C Y. Brain abscess formation: a delayed complication of carotid blowout syndrome treated by self-expandable stent-graft.  AJNR Am J Neuroradiol. 2006;  27 1543-1545