Rapid, sequential bilateral acute carotid blowout syndrome
Journal
Neuroradiology
Journal Volume
55
Journal Issue
4
Pages
475-481
Date Issued
2013
Author(s)
Abstract
Introduction: This study aims to report the treatment and outcome of sequential bilateral acute carotid artery blowout syndrome. Methods: From 2004 to 2010, we treated seven male patients with sequential bilateral blowout syndrome long after irradiation treatment for head and neck cancer. After first common carotid artery (CCA)-internal carotid artery (ICA) rupture, six were treated with CCA-ICA occlusion and one with graft stenting. The contralateral ICAs were normal or stenotic on angiography in all patients. After the contralateral CCA-ICA rupture, five patients received CCA-ICA occlusion, one received graft stent treatment, and one received no treatment. Results: Five of the seven patients died soon after the final treatment. Two patients developed cerebral infarctions (one treated with bilateral stenting, one treated with occlusion), one died from extensive local infection, one died soon after a third treatment, one died of progression of the disease, and one refused a second treatment and died soon after the diagnostic angiography. Two patients survived with follow-up periods of 1 and 5 years. In all seven patients, the contralateral CCA-ICA blowout occurred within 3 months after the first ICA occlusion. Conclusion: Bilateral ICA occlusion is an alternative management for sequential carotid artery blowout, but the mortality is high and outcome is poor. A normal angiogram cannot exclude the possibility of rapid development of a contralateral carotid artery blowout shortly after a first episode in patients who have received radiotherapy for head and neck cancer. ? 2013 Springer-Verlag Berlin Heidelberg.
SDGs
Other Subjects
adult; aged; article; bilateral acute carotid artery blowout syndrome; brain infarction; cancer mortality; cancer radiotherapy; carotid artery disease; carotid artery stenting; clinical article; common carotid artery; controlled study; disease course; external carotid artery; head and neck cancer; human; internal carotid artery; internal carotid artery occlusion; male; morbidity; priority journal; treatment outcome; Acute Disease; Adult; Aged; Carotid Artery Diseases; Fatal Outcome; Head and Neck Neoplasms; Humans; Male; Middle Aged; Postoperative Complications; Treatment Outcome
Type
journal article