Akut karotis patlamasýnda dekonstrüktif ve rekonstrüktif endovasküler tedavi paradigmalarý

AMAÇ: Karotis arteri yýrtýlmasýyla ortaya çýkan nöroonkolojik acil bir durum olan karotis patlamasý (KP), esas olarak ýþýnlanmýþ baþ ve boyun kanseri hastalarýnda rapor edilmiþtir. Bu çalýþmada bu olgularda dekonstrüktif ve rekonstrüktif endovasküler tedavi deneyimimizi sunmayý amaçladýk.
GEREÇ VE YÖNTEM: 2003 ile 2022 yýllarý arasýnda kulak, aðýz veya burun kanamasý ile baþvuran ve konservatif tedavilere yanýt vermeyen akut KP'lý 17 hasta çalýþmaya dahil edildi. Dekonstrüktif embolizasyon vasküler týkaçlar, geniþleyen hidrojel sarmallar, yapýþtýrýcý ve balon kullanýlarak yapýldý. Eðer damar anatomisi ve patolojisi uygunsa kapalý stent ile rekonstrüktif tedaviyi tercih ettik. Ýþlemlerin klinik baþarýsýný deðerlendirmek için tüm hastalar klinik ziyaretler ve modifiye Rankin skalasý ile takip edildi. Dekonstrüktif ve rekonstrüktif tedavi yöntemlerinde komplikasyon sonuçlarý ki-kare testi ile karþýlaþtýrýldý.
BULGULAR: Hastalarýn yaþ ortalamasý 20-64 (ortalama 50.9) olup, üçü kadýn (%18), 14'ü (%82) erkekti. 19 anjiyografi sýrasýnda 14 hastaya 15 en-dovasküler iþlem uyguladýk. 15 tedavinin tümünde anýnda hemostaz ve tam teknik baþarý sapþandý (p=1.0). Hastalarýn altýsýna (%35) internal karotis arterde kaplý stent kullanýlarak rekonstrüktif tedavi uygulanýrken, dokuzuna eksternal karotis arter veya internal karotis arterde (%65) dekonstrüktif embolizasyon uygulandý. Tedavi paradigmalarý (dekonstrüktif vs. rekonstrüktif) ile komplikasyon geliþimi arasýnda ki-kare baðýmsýzlýk testi kullanýlarak anlamlý bir iliþki saptanmadý X² (2, N=15) = 0.07, p=0.79.
SONUÇ: Son yýllarda ortaya çýkan endovasküler tedaviler, hayatý tehdit eden akut KP vakalarýnda umut verici sonuçlar ortaya koymaktadýr. Çalýþ-mamýz bu hastalarda uygulanan dekonstrüktif ve rekonstrüktif endovasküler paradigmalar arasýnda anlamlý bir fark bulmadý. Ancak çalýþmamýzda ve literatürdeki veriler heterojen ve yetersiz olup, kanýt düzeyinin daha yüksek olmasý gerekmektedir.

Deconstructive vs. reconstructive endovascular treatment paradigms in acute carotid blowout

BACKGROUND: Carotid Blowout (CBO), a neuro-oncological emergency characterized by the rupture of the carotid artery, has been predominantly reported in patients with head and neck cancer who have undergone radiation therapy. In this study, our objective is to share our experience with deconstructive and reconstructive endovascular treatments for CBO.
METHODS: This study includes 17 patients who experienced intractable acute CBO, presenting with ear, oral, or nasal bleeding, between 2003 and 2022. We employed deconstructive embolization using vascular plugs, expanding hydrogel coils, glue, and balloons. If vascular anatomy and pathology permitted, we opted for reconstructive treatment using a covered stent. All patients underwent clini-cal follow-up visits, and we used the modified Rankin Scale to evaluate the clinical success of the procedures. We compared outcomes in terms of complications between the deconstructive and reconstructive treatment methods using the Chi-square test.
RESULTS: The patient cohort had an age range of 20–64 years (mean 50.9), including three females (18%) and 14 males (82%). We conducted 15 endovascular procedures on 14 patients during 19 angiography sessions. All 15 treatments achieved immediate hemo-stasis, resulting in complete technical success (p=1.0). Six patients (35%) underwent reconstructive treatments with covered stents in the internal carotid artery, while nine patients (65%) underwent deconstructive embolization in either the external or internal carotid artery. We found no significant association between the treatment paradigms (deconstructive vs. reconstructive) and the development of complications using a Chi-square test of independence X² (2, n=15)=0.07, p=0.79.
CONCLUSION: Recent advancements in endovascular treatments have shown promising results in managing life-threatening acute CBO cases. Our study found no significant difference in outcomes between deconstructive and reconstructive endovascular paradigms in such patients. However, it is important to note that the available data, including ours, is heterogeneous and scarce, necessitating higher levels of evidence to draw more definitive conclusions.