Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore.
Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore.
Head Neck. 2023 Jun;45(6):1604-1614. doi: 10.1002/hed.27367. Epub 2023 Apr 10.
The objective of this study was to compare the outcomes of parent artery occlusion (PAO) versus stent-assisted reconstruction in radiated nasopharyngeal carcinoma (NPC) patients with internal carotid artery (ICA) blowouts. A retrospective review from our institution (2011-2021) and systematic review of Pubmed and Embase (1995-2022) was performed. Twenty-eight eligible studies were identified. Eighty-six PAOs and 37 stent-assisted reconstructions were analyzed, including 11 PAOs and 5 stents from our institution. Stents were associated with significantly higher incidence of overall re-bleeding (16.2% [95% CI 7.4-31.9] vs. 4.6% [95% CI 1.3-13.5], p = 0.047), delayed stroke (5.4% [95% CI 1.3-19.4] vs. 0%, p = 0.034) and reduced median survival (7.1 [95% CI 3.8-14.0] months vs. 29.0 [95% CI 9.4-63.4] months, p = 0.017) compared to PAO. There were no significant differences in terms of overall stroke, infection, extruded/migrated foreign body, and peri-procedure death. PAO is preferred over reconstructive treatment in patients with adequate collateral circulation.
本研究旨在比较血管内放射治疗后发生颈内动脉（ICA）破裂的鼻咽癌（NPC）患者中，单纯动脉闭塞（PAO）与支架辅助重建的治疗结局。我们对来自本机构（2011-2021 年）的回顾性研究以及 Pubmed 和 Embase（1995-2022 年）的系统综述进行了评估。共确定了 28 项符合条件的研究。分析了 86 例 PAO 和 37 例支架辅助重建，包括本机构的 11 例 PAO 和 5 例支架。支架组的总体再出血发生率明显更高（16.2%[95%CI 7.4-31.9]vs.4.6%[95%CI 1.3-13.5]，p=0.047）、迟发性中风（5.4%[95%CI 1.3-19.4]vs.0%，p=0.034）和中位生存期更短（7.1[95%CI 3.8-14.0]个月 vs.29.0[95%CI 9.4-63.4]个月，p=0.017），与 PAO 相比。在总体中风、感染、移植物脱出/迁移、围手术期死亡等方面，两组间无显著差异。在具有足够侧支循环的患者中，PAO 优于重建治疗。
