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Extracranial/Intracranial Vascular Bypass Preferred for Head and Neck Cancer Patients with Internal or Common Carotid Artery-Related Carotid Blowout Syndrome

by Linda Kossoff •

What is the effect of endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass on the management of patients with head and neck cancer-related rupture of the extracranial carotid artery or its major branches?

BOTTOM LINE

EC/IC vascular bypass is preferred for patients with internal or common carotid artery (ICA/CCA)-related carotid blowout syndrome (CBS) if there are more stable hemodynamics and longer expected survival.

BACKGROUND: With the prolongation of post-treatment survival for patients with head and neck cancer, CBS has become an uncommon but often fatal clinical emergency, with a mortality rate often exceeding 50%. CBS treatments include open arterial ligation, endovascular interventions, and EC/IC vascular bypass, all of which may carry immediate and delayed complications.

STUDY DESIGN: Retrospective case series.

SETTING: Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.

SYNOPSIS: Researchers examined 37 patients (23 men, 15 women, median age 53 years) with head and neck cancer-related CBS who experienced carotid blowout bleeding and were treated at a single institution. Of these, 25 were associated with external carotid artery (ECA), and 12 with ICA/CCA. Patients with ECA hemorrhage received endovascular embolization. Nine of 12 patients with ICA/CCA hemorrhage underwent EC/IC bypass; four underwent endovascular intervention. Twenty-eight patients had acute hemorrhage, four had threatened hemorrhage, and five had impending hemorrhage. Median survival for patients with ECA-related CBS was six months; 90-day, one-year, and two-year survival rates were 67.1%, 44.7%, and 33.6%, respectively. Median survival for patients with ICA/CCA-related CBS was 22.5 months; 90-day, one-year, and two-year survival rates were 92.3%, 71.8%, and 41.0%, respectively. Overall, ICA/CCA-related CBS patients had significantly longer survival times and lower rebleeding risk, potentially related to greater use of EC/IC vascular bypass. Authors conclude that EC/IC vascular bypass surgery and endovascular intervention can achieve ideal bleeding control and short-term survival, but poor prognoses in these patients may be more related to the advanced state of disease than carotid artery involvement.

CITATION: Wu P, Yuan G, Zhou R, et al. Extracranial/intracranial vascular bypass in the treatment of head and neck cancer-related carotid blowout syndrome. Laryngoscope. 2021;131:1548-1556.