Chaloupka J C, Roth T C, Putman C M, Mitra S, Ross D A, Lowlicht R A, Sasaki C T
Department of Diagnostic Radiology, Yale University School of Medicine, USA.
AJNR Am J Neuroradiol. 1999 Jun-Jul;20(6):1069-77.
To our knowledge, recurrent carotid blowout syndrome (rCBS) has not been well described. Our purpose was to review our institution's recent experience with patients who presented with multiple episodes of carotid blowout syndrome (CBS), and who were referred for emergent diagnostic angiography and endovascular therapy.
We retrospectively reviewed the last 46 consecutive patients who had a clinical diagnosis of CBS. All patients were examined and treated prospectively according to a standardized protocol. Most patients (43 of 46) had undergone extensive primary and salvage radical surgery with intraoperative brachytherapy or external beam radiation or both. The remaining three patients had either traumatic or iatrogenic CBS.
Twelve patients (26%) in our series had more than one episode of CBS in which a total of 32 (20 recurrent) events were observed (average 2.7, range 2-4). Intervals of rCBS ranged from 1 day to 6 years. Thirteen (65%) of 20 recurrent events were attributed to progressive disease (PD), and seven (35%) of 20 to treatment failures (TFs). In the PD group, seven (54%) of 13 had recurrent ipsilateral disease, and six (46%) of 13 had recurrent contralateral disease. Etiologies of rCBS were as follows: seven exposed carotids; seven carotid pseudoaneurysms; eight small-branch pseudoaneurysms; five tumor hemorrhages; three hyperemic/ulcerated wounds; and one aortic arch rupture. Twenty-seven of 32 events were treated with endovascular therapy, which included the following: nine carotid occlusions; 11 small-branch embolizations; three transarterial tumor embolizations; one carotid stent; and two direct-puncture embolizations. Four of six TFs were retreated successfully with endovascular therapy; the remaining two TFs were managed successfully by surgery. In the PD group, hemorrhagic complications of rCBS were managed successfully in all but one patient, who died. No permanent neurologic or ophthalmologic complications occurred.
Recurrent CBS is a frequently encountered problem in which most cases are caused by PD resulting from both multifocal iatrogenic arteriopathy and occasional wound complications that are characteristic of aggressively managed head and neck surgical patients. Initial TFs are encountered often as well. Despite the diagnostic and therapeutic challenges of rCBS, most cases can be retreated effectively.
据我们所知，复发性颈动脉破裂综合征（rCBS）尚未得到充分描述。我们的目的是回顾我们机构近期对出现多次颈动脉破裂综合征（CBS）发作并被转诊进行急诊诊断性血管造影和血管内治疗的患者的经验。
我们回顾性分析了连续46例临床诊断为CBS的患者。所有患者均按照标准化方案进行前瞻性检查和治疗。大多数患者（46例中的43例）接受了广泛的初次和挽救性根治性手术，并术中进行近距离放疗或外照射放疗或两者兼施。其余3例患者患有创伤性或医源性CBS。
我们系列中的12例患者（26%）发生了不止一次CBS发作，共观察到32次事件（20次复发）（平均2.7次，范围2 - 4次）。rCBS的发作间隔为1天至6年。20次复发事件中，13次（65%）归因于疾病进展（PD），7次（35%）归因于治疗失败（TF）。在PD组中，13例中有7例（54%）同侧疾病复发，13例中有6例（46%）对侧疾病复发。rCBS的病因如下：7例颈动脉暴露；7例颈动脉假性动脉瘤；8例小分支假性动脉瘤；5例肿瘤出血；3例充血/溃疡伤口；1例主动脉弓破裂。32次事件中有27次接受了血管内治疗，包括：9例颈动脉闭塞；11例小分支栓塞；3例经动脉肿瘤栓塞；1例颈动脉支架置入；2例直接穿刺栓塞。6例TF中有4例通过血管内治疗成功再次治疗；其余2例TF通过手术成功处理。在PD组中，除1例死亡患者外，rCBS的出血并发症均成功处理。未发生永久性神经或眼科并发症。
复发性CBS是一个常见问题，其中大多数病例是由多灶性医源性动脉病变和侵袭性治疗的头颈外科患者特有的偶尔伤口并发症导致的PD引起的。初次TF也经常遇到。尽管rCBS存在诊断和治疗挑战，但大多数病例可以有效再次治疗。
