Dong Fei, Li Qian, Wu JianJun, Zhang MinMing, Zhang GuangQiang, Li Bin, Jin Kai, Min Jie, Liang WeiRen, Chao Ming
Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
Springerplus. 2016 Sep 13;5(1):1553. doi: 10.1186/s40064-016-3209-y. eCollection 2016.
Carotid blowout syndrome (CBS) secondary to radiation therapy is life-threatening and requires emergency treatment. More recently, endovascular treatment has provided an effective way to control CBS-related bleeding.
We present a case of CBS with a rupture of the internal carotid artery (ICA) pseudo-aneurysm after Gamma Knife radiation therapy for nasopharyngeal carcinoma (NPC). The patient was a 55-year-old man who was transferred to our hospital with severe repetitive epistaxis. He had a history of NPC and had been treated with Gamma Knife radiation therapy 7 months prior, with a central dose of 32 Gy and marginal dose of 16 Gy. As CBS was confirmed by angiography, and the affected part of the ICA lumen exhibited moderate stenosis, the patient was successfully treated by ICA occlusion after stent implantation failure. The patient died 40 months after this operation from tumor recurrence, but without epistaxis during follow up.
Quick selection of an appropriate treatment method is very important for an acute CBS patient.
ICA occlusion can be directly considered for an acute CBS patient, if the affected ICA exhibits stenosis that is moderate or above.
放疗继发的颈动脉破裂综合征（CBS）危及生命，需要紧急治疗。最近，血管内治疗为控制CBS相关出血提供了一种有效方法。
我们报告一例鼻咽癌（NPC）患者在接受伽玛刀放疗后发生颈内动脉（ICA）假性动脉瘤破裂导致的CBS。患者为一名55岁男性，因严重反复鼻出血转入我院。他有NPC病史，7个月前接受过伽玛刀放疗，中心剂量为32Gy，边缘剂量为16Gy。经血管造影确诊为CBS，且ICA管腔受累部分呈中度狭窄，在支架植入失败后，患者通过ICA闭塞成功治疗。该患者术后40个月因肿瘤复发死亡，但随访期间未再出现鼻出血。
对于急性CBS患者，快速选择合适的治疗方法非常重要。
如果受累ICA呈现中度或以上狭窄，对于急性CBS患者可直接考虑ICA闭塞。
