Zhou Jia, Yang Kun, Zhang Xiao, Liu Zhichao, Dmytriw Adam A, Xie Weidun, Yang Kun, Wang Xue, Xu Wenlong, Wang Tao, Jiao Liqun
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
Neurological Intensive Care Unit, Tai'an Central Hospital Affiliated to Qingdao University, Tai'an, Shandong, 271000, China.
J Clin Neurosci. 2025 Mar;133:111024. doi: 10.1016/j.jocn.2024.111024. Epub 2025 Jan 5.
Carotid Blowout Syndrome (CBS) is a rare and life-threatening condition that necessitates prompt intervention to prevent fatal hemorrhage. This study compares the outcomes of two primary endovascular approaches: reconstructive interventions, which aim to preserve carotid artery function using stents or balloon angioplasty, and deconstructive interventions, which involve vessel occlusion to halt bleeding. A systematic review and meta-analysis were performed by searching multiple databases for relevant studies published from January 2000 to August 2023. A total of 28 studies involving 554 patients were included, with 214 undergoing reconstructive interventions and 340 receiving deconstructive procedures. Results indicated an overall 30-day mortality rate of 10%, with no significant difference between intervention types. However, the reconstructive group exhibited higher rates of rebleeding beyond 24 h and severe technical complications. While complication rates decreased over time, an increase in long-term mortality was noted for both approaches. These findings highlight the need for enhanced strategies in CBS management, particularly in reducing long-term mortality and addressing complications associated with reconstructive interventions.
Carotid blowout syndrome (CBS) is a rare and life-threatening condition that requires prompt intervention to prevent fatal hemorrhage. Two primary endovascular approaches are used: reconstructive interventions, which aim to preserve the carotid artery's function through stenting or balloon angioplasty, and deconstructive interventions, which focus on vessel occlusion to stop bleeding. This study aimed to compare these methods regarding prognosis, complication rates, and outcome trends over time.
A systematic review and meta-analysis were conducted, searching multiple databases for studies published from January 2000 to August 2023. Eligible studies included randomized controlled trials and observational studies reporting outcomes and complications of endovascular interventions for CBS.
The analysis included 28 studies with a total of 554 patients, of whom 214 received reconstructive interventions and 340 underwent deconstructive procedures. The overall 30-day mortality rate was 10%, with no significant difference between the two intervention types. However, the reconstructive group showed a higher incidence of rebleeding beyond 24 h and severe technical complications. While complication rates decreased over time, long-term mortality increased.
This study found no significant differences between reconstructive and deconstructive endovascular interventions in most aspects of CBS prognosis. However, reconstructive approaches, particularly those involving stents, were associated with a higher risk of rebleeding beyond 24 h and severe technical complications. Additionally, the data suggest an increase in long-term mortality rates for both methods, highlighting areas for potential improvement in CBS management and intervention strategies. Compared to previous meta-analyses, this study includes more recent and comprehensive literature, evaluating a wider range of prognostic indicators, such as transient ischemic attacks, infection rates, late-stage rebleeding, and severe procedural complications. These findings provide an updated and nuanced understanding of the risks and outcomes associated with CBS interventions, offering valuable insights that could guide clinical decision-making and future research on optimal intervention strategies.
颈动脉破裂综合征（CBS）是一种罕见且危及生命的疾病，需要及时干预以防止致命性出血。本研究比较了两种主要的血管内治疗方法的结果：重建性干预，旨在通过支架或球囊血管成形术保留颈动脉功能；解构性干预，即通过血管闭塞来止血。通过检索多个数据库，对2000年1月至2023年8月发表的相关研究进行了系统评价和荟萃分析。共纳入28项研究，涉及554例患者，其中214例接受重建性干预，340例接受解构性治疗。结果显示，总体30天死亡率为10%，不同干预类型之间无显著差异。然而，重建组24小时后再出血率和严重技术并发症发生率较高。虽然并发症发生率随时间下降，但两种方法的长期死亡率均有所上升。这些发现凸显了在CBS管理中需要加强策略，特别是在降低长期死亡率和处理与重建性干预相关的并发症方面。
颈动脉破裂综合征（CBS）是一种罕见且危及生命的疾病，需要及时干预以防止致命性出血。使用两种主要的血管内治疗方法：重建性干预，旨在通过支架置入或球囊血管成形术保留颈动脉功能；解构性干预，侧重于血管闭塞以止血。本研究旨在比较这些方法在预后、并发症发生率和随时间变化的结果趋势方面的差异。
进行了一项系统评价和荟萃分析，检索多个数据库中2000年1月至2023年8月发表的研究。符合条件的研究包括随机对照试验和观察性研究，报告CBS血管内干预的结果和并发症。
分析纳入28项研究，共554例患者，其中214例接受重建性干预，340例接受解构性治疗。总体30天死亡率为10%，两种干预类型之间无显著差异。然而，重建组24小时后再出血和严重技术并发症的发生率较高。虽然并发症发生率随时间下降，但长期死亡率有所上升。
本研究发现，在CBS预后的大多数方面，重建性和解构性血管内干预之间无显著差异。然而，重建方法，特别是涉及支架的方法，与24小时后再出血和严重技术并发症的风险较高相关。此外，数据表明两种方法的长期死亡率均有所上升，凸显了CBS管理和干预策略中潜在的改进领域。与之前的荟萃分析相比，本研究纳入了更新的综合文献，评估了更广泛的预后指标，如短暂性脑缺血发作、感染率、晚期再出血和严重手术并发症。这些发现提供了对CBS干预相关风险和结果的更新且细致入微的理解，为指导临床决策和未来最佳干预策略的研究提供了有价值的见解。
