Carotid blowout management in the endovascular era

Abstract Background Carotid blowout syndrome (CBS) is a potential complication of head and neck cancer (HNC) and its therapy associated with high morbidity and mortality. Recent advances in endovascular techniques have improved patient outcomes. In this study, we report outcomes of emergent endovascular intervention for CBS. Methods We conducted a retrospective analysis of a prospectively maintained neurovascular database and identified 38 consecutive endovascular procedures for CBS from 2008-2019 at our institution. Data collection was performed on patient demographics, type of cancer, previous cancer treatments, type of CBS, location of bleed, diagnostic work-up, endovascular treatment, and procedural outcomes and complications. Results 38 consecutive endovascular procedures for CBS were performed from 2008 through 2019 at our single academic institution. Technical success was achieved in 100% of endovascular procedures. Procedural stroke occurred in 1 (2.6%) procedure, procedural mortality occurred in 1 (2.6%) procedure, recurrent CBS occurred in 4 (10.5%) procedures, and fatal rehemorrhage occurred in 1 (2.6%) procedure. Regarding secondary outcomes, delayed stroke/TIA occurred in 1 (2.6%) procedure, while there were no cases of delayed infectious complications. Conclusion The endovascular treatment of CBS is safe and effective with relatively low rates of morbidity and mortality compared to other currently available treatment modalities. However, the overall rate of complications demands attention and sheds light on the need for further improvement in management.