Department of Neurosurgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
Hong Kong Med J. 2013 Jun;19(3):229-36. doi: 10.12809/hkmj133833. Epub 2013 May 6.
OBJECTIVES. To evaluate the efficacy and complications of endovascular treatment for ruptured internal carotid artery pseudoaneurysms following irradiation of nasopharyngeal carcinoma. DESIGN. Retrospective case series. SETTING. Tertiary neurosurgical referral unit of a Hong Kong public hospital. PATIENTS. Patients with ruptured radiation-induced internal carotid artery pseudoaneurysms that were treated endovascularly from October 1999 to October 2011 at Queen Elizabeth Hospital were reviewed. Hospital records, imaging, and angiographic data were studied. RESULTS. During the study period, 15 such nasopharyngeal carcinoma patients were treated by endovascular means at Queen Elizabeth Hospital. Ten presented with epistaxis, three with otorrhagia (bleeding from the ear), and two with both. Therapeutic occlusion of the affected internal carotid artery was performed in four patients, and stenting of the artery (with or without coil obliteration of the pseudoaneurysm) was performed in 11. Immediate haemostasis was achieved in all cases. One (7%) of the 15 patients endured symptomatic recurrence of the pseudoaneurysm, and in another an asymptomatic residual pseudoaneurysm was noted in the follow-up angiogram. Three patients suffered clinically significant procedure-related complications, including cerebral infarction (n=2) and brain abscess (n=1). In the angiograms obtained after a mean post-treatment interval of 13 (range, 0.7-60) months, the stent patency rate was 67%. All three patients with occluded stents were asymptomatic. CONCLUSIONS. Ruptured internal carotid artery pseudoaneurysms following radiotherapy is a rare but life-threatening condition. Endovascular treatment by occlusion or reconstruction of the internal carotid artery with stents provides immediate haemostasis and obliteration of the pseudoaneurysms, with a low recurrence rate. Long-term follow-up is necessary to look out for delayed post-treatment complications.
目的。评估血管内治疗鼻咽癌放疗后颈内动脉假性动脉瘤破裂的疗效和并发症。
设计。回顾性病例系列。
地点。香港公立医院的三级神经外科转诊单位。
患者。回顾了 1999 年 10 月至 2011 年 10 月期间在伊丽莎白女王医院接受血管内治疗的破裂性放射性颈内动脉假性动脉瘤患者。研究了医院记录、影像学和血管造影数据。
结果。在研究期间，伊丽莎白女王医院共收治了 15 例此类鼻咽癌患者。10 例表现为鼻出血，3 例表现为耳漏（耳出血），2 例同时表现为鼻出血和耳漏。4 例患者行受累颈内动脉闭塞治疗，11 例患者行动脉支架置入术（伴或不伴假性动脉瘤线圈闭塞）。所有病例均立即止血。15 例患者中有 1 例（7%）发生假性动脉瘤症状性复发，另 1 例在随访血管造影中发现无症状残余假性动脉瘤。3 例患者发生与手术相关的严重并发症，包括脑梗死（2 例）和脑脓肿（1 例）。在平均治疗后 13 个月（范围，0.7-60 个月）的血管造影中，支架通畅率为 67%。所有 3 例闭塞支架的患者均无症状。
结论。放疗后颈内动脉假性动脉瘤破裂是一种罕见但危及生命的情况。通过闭塞或用支架重建颈内动脉的血管内治疗可立即止血并使假性动脉瘤闭塞，复发率低。需要长期随访以观察迟发性治疗后并发症。
