Carotid Blowout Syndrome: Efficacy of Endovascular Treatment Methods

Purpose: To establish the hemostatic efficacy, complications, and outcomes of endovascular treatment for carotid blowout syndrome (CBS). Due to the rarity of this condition, the experience in endovascular treatment of CBS is not well defined. Materials and Methods: A retrospective analysis was conducted on 11 patients with head and neck cancer who underwent endovascular treatment for CBS over a 10-year period from 2004-2014 at a tertiary care center. Relevant demographic and pre-procedural clinical and laboratory data were collected. Rate of technical success of stent graft placement versus carotid occlusion via embolization was assessed with a primary endpoint of hemorrhage cessation and secondary endpoints of immediate complications and maintenance of hemostasis. Results: All patients received chemo- and radiation therapies prior to endovascular treatment for CBS and neck dissections occurred in 7 of 11 (64%) patients. Within the occlusion group (n=5), 3 patients had squamous cell carcinoma (SCC), 1 patient had adenoid cystic carcinoma, and 1 patient had chondrosarcoma. All patients within the stent group (n=6) had SCC. Active hemorrhage was present in 3 of 5 (60%) occlusion and 2 of 6 (33%) stent patients at intervention. Immediate hemostasis was achieved in all patients. One stent patient required multiple reinterventions for delayed hemorrhage. The most common complication was stroke, occurring in 2 of 5 (40%) occlusion and 1 of 6 (16%) stenting procedures. Three patients died prior to discharge (2 occlusion, 1 stent), with 6 of 8 remaining patients discharged to hospice with mean time-to-death of 8 and 39 days for occlusion and stent patients, respectively. Conclusion: Although carotid occlusion has been hypothesized as more effective in achieving immediate hemostasis for patients with CBS, it is likely to be associated with a higher rate of acute stroke due to complete cessation of blood flow through the internal carotid artery. Our findings suggest that occlusion is likely more efficacious in achieving both immediate and sustained hemostasis. However, immediate complications, such as acute stroke, appear to be less common in patients with stent placement. Keywords: Carotid Blowout Syndrome; CBS; head and neck cancer.