Article
Covered stents for hemostasis in life-threatening hemorrhage by carotid blowout syndrome in patients with head and neck cancer
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Published: | July 23, 2012 |
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Background and Purpose: Carotic blow out syndromes (CBS) by radionecrosis or tumor infiltration are rare events in patients with head and neck cancer. Intervention to binding or sewing over the bleeding vessel is associated with a mortality/morbidity of ~40%/~60%. By the use of Covert-stents (CS), the blood flow is continuously maintained and therefore cerebral complications are decreased. We investigated the safety and efficacy of intraluminal vascular stents to control these acute life-threatening bleeding.
Materials and Methods: We retrospectively evaluated the patient's history of 5 patients (4 ♂, 1 ♀). All had a history of head and neck cancer treatment and were treated acutely for a life-threatening bleeding from the carotid artery (ACC) or internal carotid artery (ACI).
Results: The analysis showed arrosion of the ACI/ACC in 2 patiens by tumor and in 3 patients by radionecrosis. In 4 patients, immediate hemostasis was achieved by implantation of a CS. In one patient the placment of a CS failed and decision for an interposition of a carotid graft was made. Periprocedural complications were observed: Neurological deficits (hemiplegia) directly occurred in 1 of 5 patients postinterventional, but are to be regarded more as a result of the massive bleeding. 4 of 5 patients died of their underlying condition in the following months, but mortality was not related to the CS or the intervention.
Conclusions: Acute life-threatening bleeding from the ACC or ACI with advanced disease in patients with head and neck cancers can be treated safely and effectively with CS.