Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Clin Neurol Neurosurg. 2024 Nov;246:108584. doi: 10.1016/j.clineuro.2024.108584. Epub 2024 Oct 3.
Carotid blowout syndrome (CBS) is a potentially life-threatening complication of head and neck cancer and associated treatment. In this study, we assess the safety and efficacy of deconstructive and reconstructive procedures with a focus on CBS recurrence.
We conducted a multicenter retrospective analysis of a prospectively maintained database and identified 80 consecutive neurointerventions for CBS from 2016 to 2020. Patients were divided into 2 groups: deconstructive embolization (68 patients) and reconstructive stenting (12 patients). A comparative analysis was performed between the two groups.
The CBS recurrence rate was 23.8 % with 84.2 % of recurrences occurring within 90 days of the primary event. The median time to rebleeding was 8.0 days (IQR: 2.0 - 28.5) with a mortality rate of 26.3 %. There was no significant difference in rates of peri-operative ischemic stroke (1.5 % vs. 0 %, p=0.672) or peri-operative mortality (1.5 % vs. 0 %, p=0.670). CBS recurrence was significantly higher in the reconstructive group (58.3 % vs. 17.6 %, p=0.002). On multivariate analysis, reconstructive stenting independently predicted rebleeding (adjusted hazard ratio 8.31, 95 % CI: 2.34-29.59, p=0.001). There was no significant association between CBS recurrence and pre-operative (p=0.600) or post-operative (p=0.275) anticoagulant/antiplatelet use.
CBS remains a challenging and potentially catastrophic complication of head and neck cancers. Reconstructive procedures, including stenting, predicted CBS recurrence independent of bleeding site or tumor invasion. Postoperative surveillance based on time intervals to CBS recurrence and engineering advancements including improved vessel reconstruction devices have the potential to reduce rehemorrhage rates and improve patient outcomes. Further clinical investigations amongst larger cohorts are needed.
颈动脉破裂综合征（CBS）是头颈部癌症及其相关治疗的一种潜在致命并发症。在本研究中，我们评估了以 CBS 复发为重点的解构和重建手术的安全性和有效性。
我们对一个前瞻性维护的数据库进行了多中心回顾性分析，并确定了 2016 年至 2020 年期间 80 例连续的 CBS 神经介入治疗。患者分为两组：解构性栓塞（68 例）和重建性支架（12 例）。对两组进行了对比分析。
CBS 的复发率为 23.8%，84.2%的复发发生在初次事件后 90 天内。再出血的中位时间为 8.0 天（IQR：2.0-28.5），死亡率为 26.3%。围手术期缺血性卒中发生率（1.5%比 0%，p=0.672）或围手术期死亡率（1.5%比 0%，p=0.670）无显著差异。重建组 CBS 复发率明显较高（58.3%比 17.6%，p=0.002）。多变量分析显示，重建性支架独立预测再出血（调整后的危险比 8.31，95%CI：2.34-29.59，p=0.001）。CBS 复发与术前（p=0.600）或术后（p=0.275）抗凝/抗血小板使用无显著相关性。
CBS 仍然是头颈部癌症的一种具有挑战性且潜在灾难性的并发症。包括支架置入在内的重建手术独立于出血部位或肿瘤侵袭预测 CBS 复发。基于 CBS 复发时间间隔和工程进展的术后监测，包括改进的血管重建装置，有可能降低再出血率并改善患者预后。需要进一步进行更大队列的临床研究。
