Endovascular Treatment of Carotid Blowout Syndrome Endovascular treatment via occlusion or stent-based reconstruction of the internal carotid artery resulted in immediate hemostasis. Carotid occlusion and covered stent application are safe and efficient techniques to treat CBS secondary to HNC.
Full Answer
How do you treat a carotid blowout?
In the case of significant carotid exposure without a history of bleeding, the focus of treatment is coverage of the artery with vascularized tissue. In patients with threatened and impending carotid blowout, angiography is required and should be both diagnostic and therapeutic.Feb 21, 2019
What is carotid blowout?
Carotid blowout syndrome (CBS) refers to a fatal hemorrhagic complication of cervical carotid arteries that occurs due to rupture of the extracranial carotid artery or one of its major branches in patients treated for head and neck malignancy.Aug 17, 2021
What causes carotid artery blowout?
The rupture of the extracranial carotid arteries or their major branches. It is an uncommon but devastating complication of head and neck cancer. Predisposing factors include: prior radiation therapy, extensive surgery, wound breakdown, local infection, tumor recurrence, and pharyngocutaneous fistulae.Dec 23, 2021
What happens when the carotid artery ruptures?
Abstract. Rupture of the carotid arteries, which provide blood supply to the head and neck, results in massive haemorrhage leading to death within a matter of minutes in 33% of cases. Those who survive are frequently left handicapped.
How is a carotid artery dissection treated?
First-line treatment for cervical artery dissection usually is antiplatelet agents (such as aspirin) or anti-coagulation to prevent the formation of blood clots. Antiplatelet drugs such as aspirin or clopidogrel may used alone or in combination.May 24, 2019
How long is the hospital stay for carotid artery surgery?
Patients usually stay in the hospital for 1 to 2 days after the surgery to allow time for recovery and time for the physician to monitor progress. You will be discharged with information about which activities you may need to limit and for how long, such as driving or physical activities.Nov 4, 2014
What are carotid precautions?
Observe standard precautions (ie, gloves, gown, masks, goggles) as appropriate. Inflate tracheostomy cuff immediately. If patient is a laryngectomy or has uncuffed tracheostomy tube in place, insert Shiley tracheostomy tube and inflate cuff. Suction as necessary to maintain patent airway.Sep 11, 2017
Can neck Tumours burst?
Carotid blowout syndrome (CBS) refers to rupture of the carotid artery and is an uncommon complication of head and neck cancer that can be rapidly fatal without prompt diagnosis and intervention.Nov 13, 2018
Can you tear an artery in your neck?
Cervical artery dissection is a condition where you have a tear in the wall of one of the large blood vessels (arteries) in your neck. This can cause blood clots in your arteries, which can affect the blood supply to your brain. Cervical artery dissection is one of the most common causes of stroke in people under 50.
What kind of doctor treats carotid aneurysm?
Any individual diagnosed with carotid occlusive disease, or who has had a transient ischemic attack (TIA, or mini-stroke) as a result of carotid stenosis or carotid occlusion should be seen by an experienced neurosurgeon.
Why would a physician perform a carotid endarterectomy?
Carotid endarterectomy (CEA) is surgery to treat carotid artery disease. The carotid arteries are the main blood vessels that carry oxygen and blood to the brain. In carotid artery disease, these arteries become narrowed. This reduces blood flow to the brain and could cause a stroke.
When does ICA become Intradural?
After this short "transitional" segment, the ICA goes through another dural ring, the distal dural ring, and then becomes intradural. The region between the two dural rings is "transitional" in location, that is, a point of transition between the two dural rings and transition from extradural to intradural.May 8, 2020
What is a CBS?
Carotid blowout syndrome (CBS), or the rupture of the common carotid artery and its branches, is a life-threatening complication of head and neck cancer and radiation therapy.
Is coil embolization safe?
Coil embolization and stent grafts may both be safe treatment options for CBS with few perioperative complications and high rates of technical success, but prognosis after treatment remains poor. In general, noncomparative studies do not demonstrate differences between the two techniques with respect to periprocedural complications and patient outcomes.
Do all treatment devices have to be durable?
As such, all treatment devices must be durable and designed with the intention of lasting for the duration of these patients' lifetimes. In addition, special care must be taken to avoid contamination of the implanted devices, and patients must continue to be monitored for infectious complications long after treatment.
Overview
Dr. Michelle J. Smith is a neurosurgeon in Bryn Mawr, Pennsylvania and is affiliated with multiple hospitals in the area, including Jefferson Health-Thomas Jefferson University Hospitals and Main Line Health Bryn Mawr Hospital.
Specialties
Neurosurgeons treat disorders of the brain and nervous system, meninges, skull, pituitary gland, spinal cord, meninges and vertebral column, and cranial and spinal nerves. They use minimally invasive surgery, neuroradiology imaging like CT, MRI, PET, MEG.
Patient Experience
Provides clear information and answers questions in a way patients understand.
Insurances Accepted
Please verify your coverage with the provider's office directly when scheduling an appointment.
Abstract
Carotid blowout syndrome (CBS) is a life-threatening disease characterized by compromise of the carotid artery by head and neck cancer (HNC).
Introduction
Carotid blowout syndrome (CBS) is a life-threatening complication of head and neck cancer (HNC).
Methods
Between April 2010 and December 2019, 12 patients with CBS due to HNC were treated endovascularly. Their hospital records were retrospectively reviewed. Computed tomography (CT) angiogram of the skull base and neck was performed on all patients to confirm the bleeding points.
Result
Twelve patients with a diagnosis of HNC presenting with acute, imminent, or threatened CBS were included in the study ( Table 1 ). Temporary hemostasis was achieved in all patients using endovascular surgery. The patients comprised 9 men and 3 women, with a mean age of 60.1 years (range: 50–81 years).
Discussion
CBS can cause severe neurological disorders or death, even if it is aggressively managed. All patients in the present study had undergone radiotherapy treatment for nasopharyngeal carcinoma. It follows that the pseudoaneurysms or irregular vessel walls had formed due to radiation.
Conclusion
CBS following radiotherapy for nasopharyngeal carcinoma is a rare but life-threatening condition that presents with epistaxis or otorrhagia. After initial hemodynamic stabilization, endovascular treatment using occlusion or ICA reconstruction with stents provided immediate hemostasis in the present study.
Contributors
Y.S conceived the study and drafted/edited the manuscript. K.M drafted/edited the manuscript. Y.T provided critical manuscript edits and feedback.
