Gaynor Brandon G, Haussen Diogo C, Ambekar Sudheer, Peterson Eric C, Yavagal Dileep R, Elhammady Mohamed Samy
Departments of *Neurosurgery and ‡Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
Neurosurgery. 2015 Aug;77(2):164-7. doi: 10.1227/NEU.0000000000000738.
Carotid blowout syndrome (CBS) is a life-threatening emergency resulting from compromise of the carotid artery caused by malignancy in the head and neck.
To report our experience with covered stents for the prevention or treatment of carotid blowout syndrome secondary to head and neck cancer to ascertain the safety and efficacy of this technique.
We reviewed the characteristics and outcome of all patients who underwent covered stent placement in the extracranial carotid artery in the setting of head and neck malignancy between 2006 and 2013 at the University of Miami. Patient demographics, presenting symptoms, devices used, perioperative complications, imaging, and follow-up data were reviewed.
Seventeen carotids in 15 patients, whose ages ranged from 20 to 84 years (mean, 70.4 years), were treated with 20 covered nitinol (Viabahn Endoprosthesis, Gore, Flagstaff, Arizona) stents. Three patients were treated acutely for bleeding from carotid blowout, and 12 were treated prophylactically for threatened carotid blowout. All patients were given periprocedural dual antiplatelet therapy. No thromboembolic or ischemic complications were noted. Hemorrhage after treatment occurred in 4 patients. In 2 patients, the hemorrhage was from a source not covered by the stent.
The use of covered stents is a simple, safe, and effective method for treating or preventing carotid blowout syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice.
颈动脉破裂综合征（CBS）是一种由头颈部恶性肿瘤导致颈动脉受损引起的危及生命的紧急情况。
报告我们使用覆膜支架预防或治疗头颈部癌继发颈动脉破裂综合征的经验，以确定该技术的安全性和有效性。
我们回顾了2006年至2013年在迈阿密大学接受头颈部恶性肿瘤患者颅外颈动脉覆膜支架置入术的所有患者的特征和结果。回顾了患者的人口统计学资料、症状表现、使用的器械、围手术期并发症、影像学检查及随访数据。
15例患者的17条颈动脉接受了治疗，患者年龄20至84岁（平均70.4岁），共使用了20枚镍钛合金覆膜（Viabahn血管内支架，戈尔公司，亚利桑那州弗拉格斯塔夫）支架。3例患者因颈动脉破裂出血接受急症治疗，12例因有颈动脉破裂风险接受预防性治疗。所有患者均接受围手术期双重抗血小板治疗。未发现血栓栓塞或缺血性并发症。4例患者治疗后出现出血。其中2例患者出血源于支架未覆盖部位。
使用覆膜支架是治疗或预防头颈部恶性肿瘤患者颈动脉破裂综合征的一种简单、安全且有效的方法。采用覆膜支架进行颈动脉重建可将与血管内或手术切除颈动脉相关的缺血性并发症风险降至最低。
