Endovascular management of carotid blowout syndrome
NEUROLOGICAL RESEARCH, vol.47, no.2, pp.122-128, 2025 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 47 Issue: 2
- Publication Date: 2025
- Doi Number: 10.1080/01616412.2024.2448635
- Journal Name: NEUROLOGICAL RESEARCH
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS
- Page Numbers: pp.122-128
- Bursa Uludag University Affiliated: Yes
Abstract
ObjectivesTo evaluate success, complications and efficacy for endovascular management for carotid blowout syndrome.MethodsImages were evaluated for contrast extravasation, vessel wall irregularity, pseudoaneurysm/aneurysm formation. Hemostatic results in the immediate postprocedural period and procedure related infarcts were assessed.ResultsTotal of 20 lesions in 21 patients were detected on digital subtraction angiography (DSA). In a case of esthesioneuroblastoma with active bleeding, DSA failed to show vascular abnormality. There was active contrast extravasation in 7 cases. Treatment modalities included covered stent placement (n = 3), pseudoaneurysm/aneurysm embolization (n = 4), parent artery occlusion (n = 13) and PVA injection (n = 1) in the immediate postoperative period was achieved in all except one case. During the post-procedural period, 6 patients (28.6%) suffered from cerebral ischemia. Rebleeding episodes were encountered in 10 cases (47.6%) after a mean duration of 35 days which responded to tamponade in 4 cases. Diagnostic DSA was performed in 5 of the cases, which failed to identify bleeding source in 2 and remaining 3 cases were treated by endovascular means. A case with massive hemorrhage 1-hour after endovascular treatment died before any intervention could be performed.ConclusionEndovascular treatment can achieve immediate hemostasis to prevent otherwise a highly morbid and mortal complication. However, rebleeding rates are high and cerebral ischemia with or without neurologic deficit occur in a non-negligible percentage of patients.