Extracranial—Intracranial Bypass for Carotid Complications in Irradiated Head and Neck Cancer Patients
Journal
Journal of Neurological Surgery Part B: Skull Base
ISSN
2193-6331
2193-634X
Date Issued
2026-06-10
Author(s)
Chen, Tzu-Hua
Huang, Chieh-Huei
Lin, Yi-Tsen
Wang, Kuo-Chuan
Liu, Chin-Nung
Abstract
Background Carotid blowout syndrome and carotid artery occlusion are rare but life-threatening complications in patients with previously irradiated head and neck cancer. Although endovascular therapy is commonly employed as a first-line treatment, extracranial-intracranial (EC-IC) bypass may be required in patients with insufficient collateral cerebral circulation. Methods We conducted a retrospective single-center case series of patients with previously irradiated head and neck cancer who underwent unilateral or bilateral EC-IC bypass between 2014 and 2025. Clinical presentation, surgical techniques, graft and donor vessel selection, and outcomes were systematically reviewed. A standardized treatment algorithm incorporating angiography and balloon occlusion testing was used to guide therapeutic decision-making. Results Eleven patients underwent a total of 15 EC-IC bypass procedures, including four bilateral cases. Radial artery (n = 9) and saphenous vein (n = 6) grafts were used, with donor vessels preferentially selected from outside irradiated fields. Anastomoses were performed to the M2 or M3 segments of the middle cerebral artery. The median overall survival was 3.75 years (interquartile range, 1-7 years). Two patients died from perioperative complications. In selected patients, EC-IC bypass effectively restored cerebral perfusion and prevented catastrophic hemorrhage. Conclusions EC-IC bypass is a feasible treatment option for selected patients with previously irradiated head and neck cancer who develop carotid complications, including bilateral disease, when careful patient selection and meticulous vessel evaluation are undertaken.
Publisher
Thieme Medical Publishers, Inc.
Type
journal article