Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China.
Department of Surgery, Division of Neurosurgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P.R. China.
Laryngoscope. 2021 Jul;131(7):1548-1556. doi: 10.1002/lary.29427. Epub 2021 Feb 11.
OBJECTIVE/HYPOTHESIS: To investigate the endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass in the management of patients with head and neck cancer-related carotid blowout syndrome (CBS).
Retrospective case series.
Retrospective analysis of clinical data of patients with head and neck cancer-related CBS treated by endovascular intervention and/or EC/IC vascular bypass, analysis of its bleeding control, neurological complications, and survival results.
Thrity-seven patients were included. Twenty-five were associated with external carotid artery (ECA); twelve were associated with internal or common carotid artery (ICA/CCA). All patients with ECA hemorrhage were treated with endovascular embolization. Of the 12 patients with ICA/CCA hemorrhage, 9 underwent EC/IC bypass, 1 underwent endovascular embolization, and 3 underwent endovascular stenting. For patients with ECA-related CBS, the median survival was 6 months, and the 90-day, 1-year, and 2-year survival rates were 67.1%, 44.7%, and 33.6%, respectively; the estimated rebleeding risk at 1-month, 6-month, and 2-year was 7.1%, 20.0%, and 31.6%, respectively. For patients with ICA/CCA-related CBS, the median survival was 22.5 months, and the 90-day, 1-year, and 2-year survival rates were 92.3%, 71.8%, and 41.0%, respectively; the estimated rebleeding risk at 1 month, 6 months, and 2 years is 7.7%,15.4%, and 15.4%, respectively. ICA/CCA-related CBS patients have significantly longer survival time and lower risk of rebleeding, which may be related to the more use of EC/IC vascular bypass as a definite treatment.
For patients with ICA/CCA-related CBS, if there is more stable hemodynamics, longer expected survival, EC/IC vascular bypass is preferred.
4 Laryngoscope, 131:1548-1556, 2021.
目的/假设：研究头颈部癌症相关颈动脉破裂综合征（CBS）患者的血管内介入或颅外/颅内（EC/IC）血管旁路治疗。
回顾性病例系列研究。
回顾性分析血管内介入和/或 EC/IC 血管旁路治疗头颈部癌症相关 CBS 患者的临床资料，分析其出血控制、神经并发症和生存结果。
共纳入 37 例患者。25 例与颈外动脉（ECA）相关，12 例与颈内或颈总动脉（ICA/CCA）相关。所有 ECA 出血患者均采用血管内栓塞治疗。12 例 ICA/CCA 出血患者中，9 例行 EC/IC 旁路手术，1 例行血管内栓塞，3 例行血管内支架植入。ECA 相关 CBS 患者的中位生存时间为 6 个月，90 天、1 年和 2 年生存率分别为 67.1%、44.7%和 33.6%；1 个月、6 个月和 2 年的估计再出血风险分别为 7.1%、20.0%和 31.6%。ICA/CCA 相关 CBS 患者的中位生存时间为 22.5 个月，90 天、1 年和 2 年生存率分别为 92.3%、71.8%和 41.0%；1 个月、6 个月和 2 年的估计再出血风险分别为 7.7%、15.4%和 15.4%。ICA/CCA 相关 CBS 患者的生存时间明显更长，再出血风险更低，这可能与更广泛地使用 EC/IC 血管旁路作为确定性治疗有关。
对于 ICA/CCA 相关 CBS 患者，如果血流动力学更稳定，预期生存时间更长，首选 EC/IC 血管旁路。
4 级《喉镜》，131：1548-1556，2021 年。
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