Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
J Neurointerv Surg. 2010 Mar;2(1):87-93. doi: 10.1136/jnis.2009.001131. Epub 2009 Oct 6.
Carotid blowout syndrome (CBS) is a high-risk condition associated with significant morbidity and mortality that may result from invasion and destruction of the cervical carotid vasculature from head and neck squamous cell carcinoma. Endovascular approaches offer multiple modalities for treatment to prevent morbidity and death. In this paper we review our experience in addressing CBS and present an up-to-date algorithm of endovascular management. 16 lesions were identified in 8 patients treated with 9 procedures over the past year. Pseudoaneurysm and/or active extravasation were documented in at least one vessel in all 8 cases presenting with acute CBS. There were 13 pseudoaneurysms in external carotid artery (ECA) trunk (5), ECA branches (4), internal carotid artery (ICA) (1) and common carotid artery (CCA) (3). There were 3 additional ICA lesions due to tumor infiltration, resulting in ICA occlusion (2) and long segment stenosis (1). Permanent vessel occlusion was performed in 11 lesions of the ECA trunk (4), ECA branches (4) and ICA (3). Stent-grafts were placed in 5 lesions in the CCA (3), ICA (1) and ECA trunk (1). Technical success and immediate hemostasis were achieved in all patients. There were no procedural deaths or immediate complications. With a median follow-up of 2 months (range, 1-13 months), three patients died: one from recurrent CBS, one from global brain ischemia after a cardiac arrest event unrelated to CBS and one from systemic disease. There was no other recurrence of bleeding or neurological complication. Endovascular techniques offer an armamentarium to effectively address CBS, significantly affecting the care and outcome in this particular oncologic population. These techniques should be offered as early as possible in the context of a multidisciplinary approach.
颈动脉破裂综合征（CBS）是一种与高发病率和死亡率相关的高危病症，可能是由于头颈部鳞状细胞癌侵犯和破坏颈总动脉血管所致。血管内方法提供了多种治疗方法，以预防发病率和死亡率。在本文中，我们回顾了我们在处理 CBS 方面的经验，并提出了一种最新的血管内治疗方法的算法。在过去一年中，我们对 8 名患者的 16 处病变进行了 9 次治疗。在所有 8 例急性 CBS 患者中，至少有 1 条血管存在假性动脉瘤和/或活动性外渗。在 ECA 干（5）、ECA 分支（4）、ICA（1）和 CCA（3）中有 13 个假性动脉瘤。还有 3 个额外的 ICA 病变是由于肿瘤浸润引起的，导致 ICA 闭塞（2）和长段狭窄（1）。永久性血管闭塞在 ECA 干（4）、ECA 分支（4）和 ICA（3）的 11 个病变中进行。支架移植物放置在 CCA（3）、ICA（1）和 ECA 干（1）的 5 个病变中。所有患者均获得技术成功和即时止血。无手术死亡或即时并发症。中位随访时间为 2 个月（范围 1-13 个月），3 例患者死亡：1 例死于复发性 CBS，1 例死于与 CBS 无关的心脏骤停事件引起的全脑缺血，1 例死于全身疾病。没有其他出血或神经并发症复发。血管内技术为有效处理 CBS 提供了一种手段，显著影响了这一特定肿瘤患者的治疗和预后。这些技术应在多学科治疗的背景下尽早提供。
