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Endovascular Management of Post-Irradiated Carotid Blowout Syndrome.

Chang FC, Luo CB, Lirng JF, Lin CJ, Lee HJ, Wu CC, Hung SC, Guo WY - PLoS ONE (2015)

Bottom Line: The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435).The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155).The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.

ABSTRACT

Purpose: To retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS).

Materials and methods: Between 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher's exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes.

Results: Technical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).

Conclusion: The outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease.

No MeSH data available.


Related in: MedlinePlus

A-B, group 1 patient. Angiogram of the left carotid artery showing a pseudoaneurysm in the lingular artery (A, arrow). It was embolized by the injection of acrylic adhesive through a microcatheter (B, arrow). C-D, group 2A patient. Angiogram of the left carotid artery showing a complex pseudoaneurysm in the distal cervical ICA (C, arrows). Embolization of the vascular lesion and the ICA with fiber coils was noted in the control angiogram (D, arrowheads).
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pone.0139821.g001: A-B, group 1 patient. Angiogram of the left carotid artery showing a pseudoaneurysm in the lingular artery (A, arrow). It was embolized by the injection of acrylic adhesive through a microcatheter (B, arrow). C-D, group 2A patient. Angiogram of the left carotid artery showing a complex pseudoaneurysm in the distal cervical ICA (C, arrows). Embolization of the vascular lesion and the ICA with fiber coils was noted in the control angiogram (D, arrowheads).

Mentions: Group 1 and group 2A patients were treated by EM with permanent embolization of the pathological lesion and/or its parent artery [7, 14]. In group 1 patients, we injected microparticles (Embosphere, Biosphere Medical, Rockland, MA; polyvinyl alcohol [Ivalon], Laboratories Nycomed S.A., Paris, France) through the microcatheter to embolize angiographic category 1 lesions and the parent artery. For angiographic category 2 lesions, we deployed microcoils (Target Therapeutics, Fremont, CA) and/or injected acrylic adhesive (Histoacryl, Braun, Germany) to occlude the pathological lesion and its parent artery (Fig 1A and 1B).


Endovascular Management of Post-Irradiated Carotid Blowout Syndrome.

Chang FC, Luo CB, Lirng JF, Lin CJ, Lee HJ, Wu CC, Hung SC, Guo WY - PLoS ONE (2015)

A-B, group 1 patient. Angiogram of the left carotid artery showing a pseudoaneurysm in the lingular artery (A, arrow). It was embolized by the injection of acrylic adhesive through a microcatheter (B, arrow). C-D, group 2A patient. Angiogram of the left carotid artery showing a complex pseudoaneurysm in the distal cervical ICA (C, arrows). Embolization of the vascular lesion and the ICA with fiber coils was noted in the control angiogram (D, arrowheads).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595276&req=5

pone.0139821.g001: A-B, group 1 patient. Angiogram of the left carotid artery showing a pseudoaneurysm in the lingular artery (A, arrow). It was embolized by the injection of acrylic adhesive through a microcatheter (B, arrow). C-D, group 2A patient. Angiogram of the left carotid artery showing a complex pseudoaneurysm in the distal cervical ICA (C, arrows). Embolization of the vascular lesion and the ICA with fiber coils was noted in the control angiogram (D, arrowheads).
Mentions: Group 1 and group 2A patients were treated by EM with permanent embolization of the pathological lesion and/or its parent artery [7, 14]. In group 1 patients, we injected microparticles (Embosphere, Biosphere Medical, Rockland, MA; polyvinyl alcohol [Ivalon], Laboratories Nycomed S.A., Paris, France) through the microcatheter to embolize angiographic category 1 lesions and the parent artery. For angiographic category 2 lesions, we deployed microcoils (Target Therapeutics, Fremont, CA) and/or injected acrylic adhesive (Histoacryl, Braun, Germany) to occlude the pathological lesion and its parent artery (Fig 1A and 1B).

Bottom Line: The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435).The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155).The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.

ABSTRACT

Purpose: To retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS).

Materials and methods: Between 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher's exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes.

Results: Technical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).

Conclusion: The outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease.

No MeSH data available.


Related in: MedlinePlus