Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
Eur J Vasc Endovasc Surg. 2024 May;67(5):708-716. doi: 10.1016/j.ejvs.2023.12.036. Epub 2024 Jan 4.
Lower neck cancers (LNCs) include specific tumour types and have some different vascular supply or collaterals from other head and neck cancers. This prospective study evaluated the outcome of endovascular management of post-irradiated carotid blowout syndrome (PCBS) in patients with LNC by comparing reconstructive management (RE) and deconstructive management (DE).
This was a single centre, prospective cohort study. Patients with LNC complicated by PCBS between 2015 and 2021 were enrolled for RE or DE. RE was performed by stent graft placement covering the pathological lesion and preventive external carotid artery (ECA) embolisation without balloon test occlusion (BTO). DE was performed after successful BTO by permanent coil or adhesive agent embolisation of the internal carotid artery (ICA) and ECA to common carotid artery, or ICA occlusion alone if the pathological lesion was ICA only. Cross occlusion included the proximal and distal ends of the pathological lesion in all patients. Re-bleeding events, haemostatic period, and neurological complications were evaluated.
Fifty-nine patients (mean age 58.5 years; 56 male) were enrolled, including 28 patients undergoing RE and 31 patients undergoing DE. Three patients originally grouped to DE were transferred to RE owing to failed BTO. The results of RE vs. DE were as follows: rebleeding events, 13/28 (46%) vs. 10/31 (32%) (p = .27); haemostatic period, 9.4 ± 14.0 months vs. 14.2 ± 27.8 months (p = .59); neurological complication, 4/28 (14%) vs. 5/31 (16%) (p = .84); and survival time, 11.8 ± 14.6 months vs. 15.1 ± 27.5 months (p = .61).
No difference in rebleeding risk or neurological complications was observed between the DE and RE groups. RE could be used as a potential routine treatment for PCBS in patients with LNC.
下颈部癌症（LNC）包括特定的肿瘤类型，其血管供应或侧支循环与其他头颈部癌症有所不同。本前瞻性研究通过比较重建治疗（RE）和解构治疗（DE），评估 LNC 患者放射性颈动脉破裂综合征（PCBS）的血管内治疗结果。
这是一项单中心前瞻性队列研究。2015 年至 2021 年间，LNC 并发 PCBS 的患者被纳入 RE 或 DE 治疗。RE 通过支架移植物覆盖病变部位并预防性进行颈外动脉（ECA）栓塞，不进行球囊试验闭塞（BTO）。DE 在成功进行 BTO 后，通过永久性线圈或粘合剂栓塞颈内动脉（ICA）和颈外动脉至颈总动脉，或如果病变部位仅为 ICA，则单独进行 ICA 闭塞。所有患者的交叉闭塞包括病变部位的近端和远端。评估再出血事件、止血时间和神经并发症。
59 名患者（平均年龄 58.5 岁；56 名男性）入组，其中 28 名患者接受 RE，31 名患者接受 DE。由于 BTO 失败，原本分组到 DE 的 3 名患者转至 RE。RE 与 DE 的结果如下：再出血事件，13/28（46%）比 10/31（32%）（p=0.27）；止血时间，9.4±14.0 个月比 14.2±27.8 个月（p=0.59）；神经并发症，4/28（14%）比 5/31（16%）（p=0.84）；生存时间，11.8±14.6 个月比 15.1±27.5 个月（p=0.61）。
在再出血风险或神经并发症方面，DE 组和 RE 组之间没有差异。RE 可作为 LNC 患者 PCBS 的一种潜在常规治疗方法。
