Tang Ru, Liu Shixian, Mao Song, Sun Xiwen, Wei Liming, Lu Haitao, Fu Jie, Zhang Weitian, Zhu Yueqi
Department of Otolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Quant Imaging Med Surg. 2024 Feb 1;14(2):1791-1802. doi: 10.21037/qims-23-604. Epub 2024 Jan 9.
Carotid blowout syndrome (CBS) frequently occurs at the distal internal carotid artery (distal-ICA) in patients with nasopharyngeal carcinoma (NPC), and remedial treatments run a high risk for neurologic complications. A case-control study was conducted to evaluate the safety and efficacy of protective stent insertion at the distal-ICA to prevent CBS in NPC patients, with a comparison to endovascular coil occlusion.
A total of 28 consecutive NPC patients at high risk of CBS from June 2019 to December 2021 in Shanghai Sixth People's Hospital (a tertiary institution) were retrospectively included and divided into a stent protection group and occlusion group. Technique feasibility, treatment outcomes and neurological deficiency were compared between the two groups by two-sample test. Kaplan-Meier analysis compared patients' survival rates at mid-term follow-up.
Stent insertion was performed in 15 patients and ICA occlusion in 13 patients. The technical success rate was 100% in both groups. Procedure-related ischemic stroke was identified in 2 patients (15.4%) in the occlusion group, compared with none in the stent protection group. Bleeding was encountered in one patient in the stent protection group and one patient in the occlusion group, each. During a median follow-up of 10.5 (range, 2-31) months, 3 patients (20%) showed asymptomatic in-stent occlusion in the stent protection group. Notably, the median survival time was significantly longer in the stent protection group than in the occlusion group (23.3 15.8 months, P=0.04).
Protective stenting the distal-ICA was similarly effective in preventing CBS in NPC patients but was safer than endovascular occlusion of ICA.
鼻咽癌（NPC）患者的颈动脉破裂综合征（CBS）常发生于颈内动脉远端（远端ICA），补救治疗存在较高的神经并发症风险。进行了一项病例对照研究，以评估在远端ICA置入保护性支架预防NPC患者发生CBS的安全性和有效性，并与血管内弹簧圈栓塞进行比较。
回顾性纳入2019年6月至2021年12月在上海第六人民医院（三级医疗机构）连续收治的28例CBS高危NPC患者，分为支架保护组和栓塞组。通过双样本检验比较两组的技术可行性、治疗结果和神经功能缺损情况。采用Kaplan-Meier分析比较患者中期随访的生存率。
15例患者进行了支架置入，13例患者进行了ICA栓塞。两组的技术成功率均为100%。栓塞组有2例患者（15.4%）发生了与手术相关的缺血性卒中，而支架保护组无。支架保护组和栓塞组各有1例患者出现出血。在中位随访10.5（范围2 - 31）个月期间，支架保护组有3例患者（20%）出现无症状的支架内闭塞。值得注意的是，支架保护组的中位生存时间显著长于栓塞组（23.3对15.8个月，P = 0.04）。
在NPC患者中，对远端ICA进行保护性支架置入在预防CBS方面同样有效，但比ICA的血管内栓塞更安全。
