Abstract
Introduction
: Carotid blow out syndrome is a life threatening emergency resulting from invasion of the carotid artery from malignancy in the head and neck. We sought to review our experience with covered stents to treat or prevent carotid blow out syndrome secondary to head and neck cancer.
Methods
: The use of covered stents in the extracranial carotid artery in the setting of head and neck malignancy between the years 2006–2013 at the University of Miami was retrospectively reviewed. Patient demographics, presenting symptoms, devices used, perioperative complications, imaging, and follow-up data were reviewed. The primary endpoint was subsequent bleeding form carotid blow out syndrome.
Results
: 12 carotids in 10 patients, ranging in age from 50 to 80 years (mean 69 years) were treated with 20 covered nitinol (Viabahn Endoprosthesis, Gore, Flagstaff, AZ) stents. Patients were treated acutely (2) for bleeding from carotid blow out or prophylactically for tumor encasement or exposure of the carotid (8). All patients were given peri-procedural dual antiplatelet therapy. There were no thromboembolic complications noted. One patient had subsequent bleeding attributable to carotid blowout syndrome from extension of disease beyond the portion of the carotid covered, which was treated acutely with the placement of an additional stent.
Conclusion
: The use of covered stents can be an effective and simple method of treating or preventing carotid blow out, obviating the need for endovascular carotid sacrifice or surgical intervention. Although there is a lack of prospective data on this subject, for patients at high risk for carotid blow out, endovascular reconstruction with covered stents can be considered for patients to prevent catastrophic hemorrhage.