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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-C, group 2B patient.Active extravasation from the pseudoaneurysm of left distal CCA was noted (E, arrow). We deployed a 10x60 mm Fluency stent-graft in the CCA (F, arrowheads) and achieved good coverage of the bleeding lesion (F, arrow). CT of the neck 6 months after curved multi-planar reconstruction of left carotid artery, showing asymptomatic septic thrombosis of the stent-graft and the carotid artery (G, arrowheads). The stent-graft was surrounded by a necrotic soft tissue lesion with abscess formation (G, arrows).
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pone.0139821.g002: A-C, group 2B patient.Active extravasation from the pseudoaneurysm of left distal CCA was noted (E, arrow). We deployed a 10x60 mm Fluency stent-graft in the CCA (F, arrowheads) and achieved good coverage of the bleeding lesion (F, arrow). CT of the neck 6 months after curved multi-planar reconstruction of left carotid artery, showing asymptomatic septic thrombosis of the stent-graft and the carotid artery (G, arrowheads). The stent-graft was surrounded by a necrotic soft tissue lesion with abscess formation (G, arrows).

Mentions: The indications for RE of group 2B patients were the patients at risk of permanent carotid occlusion, such as those with contralateral carotid occlusion, intolerance to a balloon occlusion test, or emergency status of the patient precluding an occlusion test [13, 14]. The technique of RE has been described in previous studies [14, 16]. We used a self-expandable stent-graft, including Wallgraft stent-graft (Boston Scientific Corp, Natick, Mass), Fluency stent-graft (Bard/Angiomed GmbH & Co, Karlsruhe, Germany), or Viabahn (W.L. Gore & Associates, Flagstaff, AZ, USA) (Fig 2A and 2B). Successful RE of group 2B was defined when adequate coverage of the pathologic lesion by stent graft with obliteration of the pathological vascular lesion on angiogram and clinical hemostasis was reached.


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-C, group 2B patient.Active extravasation from the pseudoaneurysm of left distal CCA was noted (E, arrow). We deployed a 10x60 mm Fluency stent-graft in the CCA (F, arrowheads) and achieved good coverage of the bleeding lesion (F, arrow). CT of the neck 6 months after curved multi-planar reconstruction of left carotid artery, showing asymptomatic septic thrombosis of the stent-graft and the carotid artery (G, arrowheads). The stent-graft was surrounded by a necrotic soft tissue lesion with abscess formation (G, arrows).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0139821.g002: A-C, group 2B patient.Active extravasation from the pseudoaneurysm of left distal CCA was noted (E, arrow). We deployed a 10x60 mm Fluency stent-graft in the CCA (F, arrowheads) and achieved good coverage of the bleeding lesion (F, arrow). CT of the neck 6 months after curved multi-planar reconstruction of left carotid artery, showing asymptomatic septic thrombosis of the stent-graft and the carotid artery (G, arrowheads). The stent-graft was surrounded by a necrotic soft tissue lesion with abscess formation (G, arrows).
Mentions: The indications for RE of group 2B patients were the patients at risk of permanent carotid occlusion, such as those with contralateral carotid occlusion, intolerance to a balloon occlusion test, or emergency status of the patient precluding an occlusion test [13, 14]. The technique of RE has been described in previous studies [14, 16]. We used a self-expandable stent-graft, including Wallgraft stent-graft (Boston Scientific Corp, Natick, Mass), Fluency stent-graft (Bard/Angiomed GmbH & Co, Karlsruhe, Germany), or Viabahn (W.L. Gore & Associates, Flagstaff, AZ, USA) (Fig 2A and 2B). Successful RE of group 2B was defined when adequate coverage of the pathologic lesion by stent graft with obliteration of the pathological vascular lesion on angiogram and clinical hemostasis was reached.

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