Chang Feng-Chi, Luo Chao-Bao, Lirng Jiing-Feng, Lin Chung-Jung, Lee Han-Jui, Wu Chih-Chun, Hung Sheng-Che, Guo Wan-Yuo
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang Ming University, School of Medicine, Taipei, Taiwan.
PLoS One. 2015 Oct 6;10(10):e0139821. doi: 10.1371/journal.pone.0139821. eCollection 2015.
To retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS).
Between 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher's exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes.
Technical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3-110] vs 3.6±4.0[0.07-22] months, P<0.0001).
The outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease.
回顾性评估与头颈部癌伴放疗后颈动脉破裂综合征（PCBS）患者血管内治疗结局相关的临床和技术因素。
2000年至2013年期间，96例PCBS患者接受了血管内治疗。40例病理病变位于颈外动脉的患者被归类为第1组，并接受栓塞治疗。另外56例病理病变位于颈动脉主干的患者分为以下2组：第2A组包括38例接受栓塞治疗的患者，第2B组包括18例接受支架植入治疗的患者。采用Fisher精确检验来检验血管内治疗方法、临床严重程度和术后临床疾病作为结局预测指标的情况。
所有患者均实现了技术成功和即刻止血。根据血管内治疗方法（第1组 vs 第2A组 vs 第2B组）的结果如下：技术并发症（1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%]，P = 0.0001）；再出血（14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]），P = 0.0435）。根据临床严重程度（急性PCBS vs 持续性PCBS）的结果如下：技术并发症（15/47[31.9%] vs 4/49[8.2%]，P = 0.0035）；再出血（18/47[38.3%] vs 8/49[16.3%]，P = 0.0155）。根据术后临床疾病（退行性改变 vs 进展性改变）的结果如下：存活（14/21[66.7%] vs 8/75[10.7%]，P<0.0001）；生存时间（34.1±30.6[0.3 - 110] vs 3.6±4.0[0.07 - 22]个月，P<0.0001）。
通过将栓塞作为优先治疗方式、在临床严重程度较轻时进行血管内干预以及积极处理术后临床疾病，可以改善PCBS血管内治疗的结局。
